Formulations and methods for vascular permeability-related diseases or conditions

ABSTRACT

Described herein are formulations and methods for treating, inhibiting, preventing, delaying onset, or causing regression of a disease or condition relating to vascular permeability.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. application Ser. No.13/530,025, filed Jun. 21, 2012, which is a continuation of U.S.application Ser. No. 11/726,813, filed Mar. 23, 2007, now U.S. Pat. No.8,222,271, which is related to and claims priority from U.S. ProvisionalPatent Application Ser. No. 60/785,814, filed Mar. 23, 2006, which areincorporated herein by reference in their entirety.

FIELD

Described herein are formulations and methods for treatment, prevention,inhibition, delaying onset of, or causing regression of a vascularpermeability-related disease or condition by delivery of a formulationcomprising a therapeutic agent to a subject in need thereof, includingbut not limited to a human subject. In some variations the therapeuticagent includes limus compounds and immunophilin binding compounds,including but not limited to rapamycin (sirolimus).

BACKGROUND

The development and maturation of blood vessels results from a complexinterplay of pro- and anti-angiogenic regulators. Dysregulation of thebalance between these factors is thought to result in the formation ofpathological blood vessels, such as blood vessels with increasedvascular permeability (Bergers and Benjamin, Nat. Rev. Cancer 3:401-410,2003). Increased vascular permeability has been implicated in numerouspathologies; non-limiting examples include vascular diseases anddisorders of the eye, diabetes, cancer, pulmonary hypertension, andvarious edemas.

As one non-limiting example, consider the eye. The eye contains highlyvascularized and completely avascular tissues in close apposition. Thisspecialized anatomy requires regulation of the balance between vascularquiescence and vascular growth (Schlingemann et al., Br. J. Ophthalmol.81:501-51, 1991). In eye diseases associated with angiogenesis andvascular permeability, this delicate balance is disturbed. Some leadingcauses of severe vision loss and blindness are ocular-related disorderswherein the vasculature of the eye is damaged or insufficientlyregulated. Ocular-related diseases with a vascular permeability elementinclude, for example, exudative age-related macular degeneration,diabetic retinopathy, corneal neovascularization, choroidalneovascularization, neovascular glaucoma, cyclitis, Hippel-Lindaudisease, reinopathy of prematurity, pterygium, histoplasmosis, irisneovasularization, macular edema, glaucoma-associatedneovascularization, and the like. Vision loss may be caused by increasedvessel permeability, or increased vessel permeability may be correlatedwith one or more symptoms which impair the eye's function or otherwiseinconvenience or cause discomfort in the patient. As non-limitingexamples, accumulation of fluid within the eye and the vitreal cavitycan instigate retinal detachment, degeneration of sensory cells of theeye, increased intraocular pressure, and inflammation, all of whichadversely affect vision and the general health of the eye.

As another non-limiting example, there are two kinds of diabeticretinopathy. The first is non-proliferative retinopathy, which is anearlier stage of the disease characterized by increased capillarypermeability, microaneurysms, hemorrhages, exudates, and edema. Mostvision loss during this stage is due to the fluid accumulating in themacula due to vascular leakage. This accumulation of fluid is calledmacular edema and can cause temporary or permanent decreased vision.Prolonged periods of vascular leakage can ultimately lead to thethickening of the basement membrane and formation of soft and hardexudates. The second category of diabetic retinopathy is calledproliferative retinopathy and is characterized by abnormal new vesselformation, which grows on the vitreous surface or extends into thevitreous cavity. These newly formed blood vessels of the retina orchoroid are often permeable, which allows leakage of vascular fluid intothe surrounding tissue and formation of fibrotic tissue and scarring.The leakage of material from the vasculature into the tissues of the eyeand scarring can lead to vision loss.

For many ocular-related disorders, including retinal, choroidal, andmacular edema, there are no efficient therapeutic options currentlyavailable. Laser photocoagulation is employed to administer laser burns.For example, focal macular photocoagulation is used to treat areas ofvascular leakage outside the macula (Murphy, Amer. Family Physician51:785-796, 1995). Advanced proliferative retinopathy is commonlytreated with scatter or panretinal photocoagulation. The laser treatmentmay cause permanent blind spots corresponding to the treated areas.Laser treatment may also cause persistent or recurrent hemorrhage,induce neovascularization or fibrosis, or increase risk of retinaldetachment. In addition, some patients fail to respond to lasertreatments.

Treatments for ocular diseases or conditions and other types ofpermeability-related diseases or conditions which have decreaseddangerous side-effects would be advantageous.

Another disease or disorder characterized by increased vascularpermeability is pulmonary hypertension. Pulmonary hypertension is a rareblood vessel disorder of the lung in which the pressure in the pulmonaryartery (the blood vessel leading from the heart to the lungs) risesabove normal levels and may become life threatening. One cause ofpulmonary hypertension is alveolar hypoxia, which results from localizedinadequate ventilation of well-perfused alveoli or from a generalizeddecrease in alveolar ventilation. Pulmonary hypertension is also avascular permeability related disease. Pulmonary hypertension has beenhistorically chronic and incurable with a poor survival rate. Treatmentof pulmonary hypertension usually involves continuous use of oxygen.Pulmonary vasodilators (e.g., hydralazine, calcium blockers, nitrousoxide, prostacyclin) have not proven effective, and lung transplant isoften required for patients who do not respond to therapy.

While illustrative ocular disorders and pulmonary hypertension weredescribed above, they are merely non-limiting examples of a few of thetypes of problems which can be caused by increased vascularpermeability. In addition to ocular diseases and disorders and pulmonaryhypertension, increased vascular permeability has been found to play arole in the pathophysiology of a variety of other diseases anddisorders.

Despite the prevalence of vascular permeability-related disorders, thereremains a need for better therapeutic treatments thereof.

SUMMARY

Described herein are methods of treating, inhibiting, preventing,delaying onset, or causing regression of a disease or condition relatingto vascular permeability, wherein the method comprises administering aneffective amount of a formulation comprising a therapeutic agent to asubject in need thereof, wherein the therapeutic agent is a limuscompound, or a pharmaceutically acceptable prodrug, analog, salt, ester,or derivative thereof.

Described herein are methods of treating, inhibiting, preventing,delaying onset, or causing regression of a disease or condition relatingto vascular permeability, wherein the method comprises administering aneffective amount of a formulation comprising a therapeutic agent to asubject in need thereof, wherein the therapeutic agent is animmunophilin binding compound, or a pharmaceutically acceptable prodrug,analog, salt, ester, or derivative thereof.

In some variations the therapeutic agent is a limus compound orpharmaceutically acceptable salt or ester thereof.

In some variations the therapeutic agent is an immunophilin bindingcompound or pharmaceutically acceptable salt or ester thereof.

Described herein are methods of treating, inhibiting, preventing,delaying onset, or causing regression of a disease or condition relatingto vascular permeability, wherein the method comprises administering aneffective amount of a formulation comprising a therapeutic agent to asubject in need thereof, wherein the therapeutic agent is selected fromthe group consisting of rapamycin, SDZ-RAD, tacrolimus, everolimus,pimecrolimus, CCI-779, AP23841, ABT-578, TAFA-93, RAD-001, temsirolimus,AP23573, 7-epi-rapamycin, 7-thiomethyl-rapamycin,7-epi-trimethoxyphenyl-rapamycin, 7-epi-thiomethyl-rapamycin,7-demethoxy-rapamycin, 32-demethoxy-rapamycin, 2-desmethyl-rapamycin,monoester derivatives of rapamycin, diester derivatives of rapamycin,27-oximes of rapamycin; 42-oxo analogs of rapamycin; bicyclicrapamycins; rapamycin dimers; silyl ethers of rapamycin; rapamycinarylsulfonates, rapamycin sulfamates, monoesters at positions 31 and 42,diesters at positions 31 and 42, 30-demethoxy rapamycin, andpharmaceutically acceptable salts and esters thereof.

In some variations the therapeutic agent is selected from the groupconsisting of rapamycin, SDZ-RAD, tacrolimus, everolimus, pimecrolimus,CCI-779, AP23841, ABT-578, and pharmaceutically acceptable salts andesters thereof.

In some variations the amount of therapeutic agent in the formulation isequivalent to between 20 μg and 4 mg of rapamycin.

In some variations the disease or condition relating to vascularpermeability is selected from the group consisting of edema associatedwith capillary leak, edema associated with capillary permeability,diseases with edema as a complication, edema associated with venousobstruction, edema associated with lymphatic obstruction, edemaassociated with pulmonary disease, edema associated with infectiousconditions, edema associated with inflammatory, noninfectious, orautoimmune conditions, edema associated with neurologic conditions,edema associated with neoplasms or tumors, diseases associated withdermatologic diseases or conditions, edema associated with genetic,congenital, or cystic abnormalities, edema due to environmental or otherexposure, edema caused by acute trauma or injury, edema associated withinfarction and ischemia reperfusion, miscellaneous causes of edema, oredema associated with systemic conditions.

In some variations the disease or condition relating to vascularpermeability is selected from the group consisting of cardiomyopathy,dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictivecardiomyopathy, congestive heart failure, filariasis, kidney failure,lymphedema, preeclampsia, eclampsia, thyroid condition, varicosity,varicose veins, aortic coarcation, cor pulmonale, exudative dermatitis,Hodgkin's disease, pericarditis, nephrogenic pulmonary edema,thrombophlebitis, thrombosis, neoplasm, varicosity, arteriovenousfistula, lymph node mass, aneurysm, filariasis, cellulitis, neoplasm,surgical excision, pulmonary edema, chronic obstructive pulmonarydisease, pleural effusion, aspiration pneumonitis, asthma induced edema,amniotic fluid embolism, boils, carbuncle, abscess, erysipelas,osteomyelitis, gas gangrene, erysipelas, anthrax, Ludwig's angina,parasitic infections, trichinosis, viral encephalitis, AIDS, herpessimplex virus infection, herpes zoster virus infection, tuberculosis(disseminated, military, etc.), neurosyphilis, prion diseases,meningitis, pneumococcal meningitis, rabies, neuroretinitis, anthraxexposure, endotoxin induced edema, Wegeners granulomatosis, Sjogren'ssyndrome, scleroderma, systemic Lupus erythematosis, sarcoidosis,multiple sclerosis, Reiter's syndrome, Pyogenic granuloma, vasculitis,demyelinating diseases, benign intracranial hypertension, papilledema,optic neuritis, multi-infarct dementia, Alzheimers disease, amyloiddeposition diseases, toxic metabolic brain edema, cerebral amyloidangiopathy, post-ictal state, blood brain barrier dysfunction,Vogt-Koyanagi-Harada syndrome, prophylactic use in carotidendarterectomy, vasogenic brain edema, choroidal melanoma, choroidalnevus, melanoma, neuroma, epithelioma, lymphangioma, myxoma, fibroma,fibromyoma, osteoma, chondroma, angioma, angiosarcoma, peritumoral brainedema, hemangiomas, carcinoid, multiple endocrine neoplasia, porphyriacutanea tarda, pemphigoid, dermatitis herpetiformis, pemphigous,empitigo, erythema multiforme, exudative dermatitis, epidermolysisbullosa, contact dermatitis, actinic dermatitis, toxic erythema,dermatomyositis, eczema, toxic epidermal necrolysis, xerodermapigmentosa, hydrocoele, dermoid cyst, ovarian cyst, amniotic band,arteriovenous fistula, meningocoele, hydrocephalus, hereditaryangioneurotic edema, neurofibromatosis, Von Hippel Lindau disease,tuberous sclerosis, acute nephritis, angioneurotic edema, scleroderma,hypersensitivity reactions, transfusion reactions, acute mountainsickness, high altitude pulmonary edema (HAPE), high altitude cerebraledema (HACE), tropical edema, chilblains, drug toxicity, poisonings,anoxia due to smoke inhalation, carbon monoxide poisoning, or neardrowning, exposure to noxious gases, poison ivy, poison oak, poisonsumac, or nettles exposure, cholinergic intoxication, edema fromsystemic steroid therapy, ethanol induced brain injury, hyponatremicbrain edema, acute trauma from bone, joint, soft tissue, or organinjury, prophylactic treatment to prevent swelling in athletics orsporting activities, bruise, contusion, ligamentous sprain or tendonousstrain, bursitis, joint injuries, fracture, insect bite, snake bite,insect bites, marine intoxications or envenomations due to sponges,corals, sea anemones, sea urchins, sting ray, scorpion fish, or jellyfish stings, exposure to an irritant or corrosive, frostbite, burn,sunburn, electrical injury, traumatic brain injury, spinal cord injury,traumatic optic neuropathy, subdural hematoma, subarachnoid hematoma,carotid cavernous fistula, stroke, myocardial infarction, arterialobstruction, arterial laceration, extremity amputation requiringreplantation, central retinal artery occlusion, branch retinal arteryocclusion, anterior or posterior ischemic optic neuropathy, ischemiainduced edema, gout, angioneurotic edema, Milroy's disease, cornealedema, episceritis, scleritis, choroidal effusion, conjunctival edema,exudative retinal detachment, ventriculoperitoneal shunt malfunction,CSF drainage obstruction, aphthous ulcer, leukoplakia, epiglotitis,cytotoxic edema, laryngeal edema, chronic cough, lichen planus,pancreatitis, blepharitis, eyelid swelling, polymyositis, anaphylacticshock, shock, sepsis, acute respiratory distress syndrome (ARDS),intensive care patient, heart lung bypass induced brain edema, coldinduced brain edema, hepatic failure induced brain edema, sympatheticophthalmia, sarcoma, high altitude retinal hemorrhages, blunt andpenetrating ocular and orbital trauma, hypertensive retinopathy, macularstar, orbital cellulitis, choroidal infarction, frosted branch angiitis,sickle cell disease, papillomas, keratitis, dacryoadenitis,canaliculitis, dacryocystitis, contact lens induced conjunctivitis,interstitial keratitis, ligneous conjunctivitis, pinguecula, pterygium,cornea gutata, adenomas, capillary hemangioma, cavernous hemangioma,hemangioendothelioma, hemangiopericytoma, kaposi's sarcoma, choristoma,benign reactive lymphoid hyperplasia, lymphoid neoplasia, hordeolum,chalazion, xanthomatous tumors, corneal graft edema, and corneal edemaassociated with refractive procedures, and ptosis.

In some variations the disease or condition is a member from the groupconsisting of cellulitis, eyelid edema, neoplasm, herpes simplex virusinfection, herpes zoster virus infection, tuberculosis, neurosyphilis,Wegeners granulomatosis, Sjogren's syndrome, scleroderma, systemic Lupuserythematosis, sarcoidosis, multiple sclerosis, Reiter's syndrome,Pyogenic granuloma, vasculitis, or demyelinating diseases, pappiledema,optic neuritis, amyloid deposition diseases, Vogt-Koyanagi-Haradasyndrome, choroidal melanoma, choroidal nevus, melanoma, neuroma,epithelioma, lymphangioma, myxoma, fibroma, fibromyoma, osteoma,chondroma, hemangioma, Rosacea, dermatitis, pemphigoid, erythemamultiforme, neurofibromatosis, Von Hippel Lindau disease, or tuberoussclerosis, hypersensitivity reactions, drug toxicity, acute trauma,insect bite, burn, traumatic optic neuropathy, carotid cavernousfistula, central retinal artery occlusion, branch retinal arteryocclusion, anterior or posterior ischemic optic neuropathy, or ischemiainduced edema, corneal edema, episceritis, scleritis, choroidaleffusion, conjunctival edema, exudative retinal detachment,ventriculoperitoneal shunt malfunction, CSF drainage obstruction,blepharitis, eyelid swelling

Described herein are methods to treat the diseases or conditionsdescribed herein.

Described herein are methods to prevent the disease or condition.

In some variations the formulation comprising the therapeutic agent isplaced rectally, vaginally, by infusion, intramuscularly,intraperitoneally, intraarterially, intrathecally, intrabronchially,intracisternally, cutaneously, subcutaneously, intradermally,transdermally, intravenously, intracervically, intraabdominally,intracranially, intraocularly, periocularly, intrapulmonarily,intrathoracically, intratracheally, nasally, buccally, sublingually,orally, parenterally, topically, by implantation, as part of anembolization procedure, transcutaneously, directly into a nerve,directly into the optic nerve, direct injection into the optic nervehead, transretinally, transsclerally into an area of effusion orexudation, or inhaled after nebulisation or aerosolization.

Described herein are methods of treatment comprising administering aformulation comprising an effective amount of a limus compound to treat,prevent, inhibit, delay onset of, or cause regression of any one or moreof cardiomyopathy, dilated cardiomyopathy, hypertrophic cardiomyopathy,restrictive cardiomyopathy, congestive heart failure, filariasis, kidneyfailure, lymphedema, preeclampsia, eclampsia, thyroid condition,varicosity, varicose veins, aortic coarcation, cor pulmonale, exudativedermatitis, Hodgkin's disease, pericarditis, nephrogenic pulmonaryedema, varicosity, arteriovenous fistula, lymph node mass, aneurysm,filariasis, neoplasm, surgical excision, pulmonary edema, chronicobstructive pulmonary disease, pleural effusion, aspiration pneumonitis,asthma induced edema, amniotic fluid embolism, boils, carbuncle,abscess, erysipelas, osteomyelitis, gas gangrene, erysipelas, anthrax,Ludwig's angina, parasitic infections, trichinosis, viral encephalitis,AIDS, herpes simplex virus infection, prion diseases, rabies,neuroretinitis, anthrax exposure, endotoxin induced edema, Wegenersgranulomatosis, Sjogren's syndrome, scleroderma, systemic Lupuserythematosis, multiple sclerosis, Pyogenic granuloma, vasculitis,demyelinating diseases, benign intracranial hypertension, multi-infarctdementia, Alzheimers disease, amyloid deposition diseases, toxicmetabolic brain edema, cerebral amyloid angiopathy, post-ictal state,blood brain barrier dysfunction, prophylactic use in carotidendarterectomy, vasogenic brain edema, choroidal nevus, neuroma,epithelioma, lymphangioma, myxoma, fibroma, fibromyoma, osteoma,chondroma, angioma, angiosarcoma, peritumoral brain edema, hemangiomas,carcinoid, multiple endocrine neoplasia, porphyria cutanea tarda,pemphigoid, dermatitis herpetiformis, pemphigous, empitigo, erythemamultiforme, exudative dermatitis, epidermolysis bullosa, contactdermatitis, actinic dermatitis, toxic erythema, dermatomyositis, eczema,toxic epidermal necrolysis, xeroderma pigmentosa, hydrocoele, dermoidcyst, ovarian cyst, amniotic band, arteriovenous fistula, meningocoele,hydrocephalus, hereditary angioneurotic edema, neurofibromatosis, VonHippel Lindau disease, tuberous sclerosis, acute nephritis,angioneurotic edema, scleroderma, hypersensitivity reactions,transfusion reactions, acute mountain sickness, high altitude pulmonaryedema (HAPE), high altitude cerebral edema (HACE), tropical edema,chilblains, drug toxicity, poisonings, anoxia due to smoke inhalation,carbon monoxide poisoning, or near drowning, exposure to noxious gases,poison ivy, poison oak, poison sumac, or nettles exposure, cholinergicintoxication, edema from systemic steroid therapy, ethanol induced braininjury, hyponatremic brain edema, acute trauma from bone, joint, softtissue, or organ injury, prophylactic treatment to prevent swelling inathletics or sporting activities, ligamentous sprain or tendonousstrain, bursitis, joint injuries, fracture, insect bite, snake bite,insect bites, marine intoxications or envenomations due to sponges,corals, sea anemones, sea urchins, sting ray, scorpion fish, or jellyfish stings, frostbite, electrical injury, traumatic brain injury,spinal cord injury, traumatic optic neuropathy, subdural hematoma,subarachnoid hematoma, carotid cavernous fistula, stroke, myocardialinfarction, arterial obstruction, arterial laceration, extremityamputation requiring replantation, gout, angioneurotic edema, Milroy'sdisease, corneal edema, choroidal effusion, conjunctival edema,ventriculoperitoneal shunt malfunction, CSF drainage obstruction,aphthous ulcer, leukoplakia, epiglotitis, cytotoxic edema, laryngealedema, chronic cough, lichen planus, pancreatitis, polymyositis,anaphylactic shock, shock, sepsis, acute respiratory distress syndrome(ARDS), intensive care patient, heart lung bypass induced brain edema,cold induced brain edema, hepatic failure induced brain edema, highaltitude retinal hemorrhages, macular star, choroidal infarction,frosted branch angiitis, papillomas, dacryoadenitis, canaliculitis,cornea gutata, adenomas, capillary hemangioma, cavernous hemangioma,hemangioendothelioma, hemangiopericytoma, choristoma, benign reactivelymphoid hyperplasia, lymphoid neoplasia, corneal graft edema, andcorneal edema associated with refractive procedures.

Described herein are methods of treatment comprising administering aformulation comprising an effective amount of an immunophilin bindingcompound to treat, prevent, inhibit, delay onset of, or cause regressionof any one or more of cardiomyopathy, dilated cardiomyopathy,hypertrophic cardiomyopathy, restrictive cardiomyopathy, congestiveheart failure, filariasis, kidney failure, lymphedema, preeclampsia,eclampsia, thyroid condition, varicosity, varicose veins, aorticcoarcation, cor pulmonale, exudative dermatitis, Hodgkin's disease,pericarditis, nephrogenic pulmonary edema, varicosity, arteriovenousfistula, lymph node mass, aneurysm, filariasis, neoplasm, surgicalexcision, pulmonary edema, chronic obstructive pulmonary disease,pleural effusion, aspiration pneumonitis, asthma induced edema, amnioticfluid embolism, boils, carbuncle, abscess, erysipelas, osteomyelitis,gas gangrene, erysipelas, anthrax, Ludwig's angina, parasiticinfections, trichinosis, viral encephalitis, AIDS, herpes simplex virusinfection, prion diseases, rabies, neuroretinitis, anthrax exposure,endotoxin induced edema, Wegeners granulomatosis, Sjogren's syndrome,scleroderma, systemic Lupus erythematosis, multiple sclerosis, Pyogenicgranuloma, vasculitis, demyelinating diseases, benign intracranialhypertension, multi-infarct dementia, Alzheimers disease, amyloiddeposition diseases, toxic metabolic brain edema, cerebral amyloidangiopathy, post-ictal state, blood brain barrier dysfunction,prophylactic use in carotid endarterectomy, vasogenic brain edema,choroidal nevus, neuroma, epithelioma, lymphangioma, myxoma, fibroma,fibromyoma, osteoma, chondroma, angioma, angiosarcoma, peritumoral brainedema, hemangiomas, carcinoid, multiple endocrine neoplasia, porphyriacutanea tarda, pemphigoid, dermatitis herpetiformis, pemphigous,empitigo, erythema multiforme, exudative dermatitis, epidermolysisbullosa, contact dermatitis, actinic dermatitis, toxic erythema,dermatomyositis, eczema, toxic epidermal necrolysis, xerodermapigmentosa, hydrocoele, dermoid cyst, ovarian cyst, amniotic band,arteriovenous fistula, meningocoele, hydrocephalus, hereditaryangioneurotic edema, neurofibromatosis, Von Hippel Lindau disease,tuberous sclerosis, acute nephritis, angioneurotic edema, scleroderma,hypersensitivity reactions, transfusion reactions, acute mountainsickness, high altitude pulmonary edema (HAPE), high altitude cerebraledema (HACE), tropical edema, chilblains, drug toxicity, poisonings,anoxia due to smoke inhalation, carbon monoxide poisoning, or neardrowning, exposure to noxious gases, poison ivy, poison oak, poisonsumac, or nettles exposure, cholinergic intoxication, edema fromsystemic steroid therapy, ethanol induced brain injury, hyponatremicbrain edema, acute trauma from bone, joint, soft tissue, or organinjury, prophylactic treatment to prevent swelling in athletics orsporting activities, ligamentous sprain or tendonous strain, bursitis,joint injuries, fracture, insect bite, snake bite, insect bites, marineintoxications or envenomations due to sponges, corals, sea anemones, seaurchins, sting ray, scorpion fish, or jelly fish stings, frostbite,electrical injury, traumatic brain injury, spinal cord injury, traumaticoptic neuropathy, subdural hematoma, subarachnoid hematoma, carotidcavernous fistula, stroke, myocardial infarction, arterial obstruction,arterial laceration, extremity amputation requiring replantation, gout,angioneurotic edema, Milroy's disease, corneal edema, choroidaleffusion, conjunctival edema, ventriculoperitoneal shunt malfunction,CSF drainage obstruction, aphthous ulcer, leukoplakia, epiglotitis,cytotoxic edema, laryngeal edema, chronic cough, lichen planus,pancreatitis, polymyositis, anaphylactic shock, shock, sepsis, acuterespiratory distress syndrome (ARDS), intensive care patient, heart lungbypass induced brain edema, cold induced brain edema, hepatic failureinduced brain edema, high altitude retinal hemorrhages, macular star,choroidal infarction, frosted branch angiitis, papillomas,dacryoadenitis, canaliculitis, cornea gutata, adenomas, capillaryhemangioma, cavernous hemangioma, hemangioendothelioma,hemangiopericytoma, choristoma, benign reactive lymphoid hyperplasia,lymphoid neoplasia, corneal graft edema, and corneal edema associatedwith refractive procedures.

Described herein are methods of treatment comprising administering aformulation comprising an effective amount of a therapeutic agent totreat, prevent, inhibit, delay onset of, or cause regression of any oneor more of cardiomyopathy, dilated cardiomyopathy, hypertrophiccardiomyopathy, restrictive cardiomyopathy, congestive heart failure,filariasis, kidney failure, lymphedema, preeclampsia, eclampsia, thyroidcondition, varicosity, varicose veins, aortic coarcation, cor pulmonale,exudative dermatitis, Hodgkin's disease, pericarditis, nephrogenicpulmonary edema, varicosity, arteriovenous fistula, lymph node mass,aneurysm, filariasis, neoplasm, surgical excision, pulmonary edema,chronic obstructive pulmonary disease, pleural effusion, aspirationpneumonitis, asthma induced edema, amniotic fluid embolism, boils,carbuncle, abscess, erysipelas, osteomyelitis, gas gangrene, erysipelas,anthrax, Ludwig's angina, parasitic infections, trichinosis, viralencephalitis, AIDS, herpes simplex virus infection, prion diseases,rabies, neuroretinitis, anthrax exposure, endotoxin induced edema,Wegeners granulomatosis, Sjogren's syndrome, scleroderma, systemic Lupuserythematosis, multiple sclerosis, Pyogenic granuloma, vasculitis,demyelinating diseases, benign intracranial hypertension, multi-infarctdementia, Alzheimers disease, amyloid deposition diseases, toxicmetabolic brain edema, cerebral amyloid angiopathy, post-ictal state,blood brain barrier dysfunction, prophylactic use in carotidendarterectomy, vasogenic brain edema, choroidal nevus, neuroma,epithelioma, lymphangioma, myxoma, fibroma, fibromyoma, osteoma,chondroma, angioma, angiosarcoma, peritumoral brain edema, hemangiomas,carcinoid, multiple endocrine neoplasia, porphyria cutanea tarda,pemphigoid, dermatitis herpetiformis, pemphigous, empitigo, erythemamultiforme, exudative dermatitis, epidermolysis bullosa, contactdermatitis, actinic dermatitis, toxic erythema, dermatomyositis, eczema,toxic epidermal necrolysis, xeroderma pigmentosa, hydrocoele, dermoidcyst, ovarian cyst, amniotic band, arteriovenous fistula, meningocoele,hydrocephalus, hereditary angioneurotic edema, neurofibromatosis, VonHippel Lindau disease, tuberous sclerosis, acute nephritis,angioneurotic edema, scleroderma, hypersensitivity reactions,transfusion reactions, acute mountain sickness, high altitude pulmonaryedema (HAPE), high altitude cerebral edema (HACE), tropical edema,chilblains, drug toxicity, poisonings, anoxia due to smoke inhalation,carbon monoxide poisoning, or near drowning, exposure to noxious gases,poison ivy, poison oak, poison sumac, or nettles exposure, cholinergicintoxication, edema from systemic steroid therapy, ethanol induced braininjury, hyponatremic brain edema, acute trauma from bone, joint, softtissue, or organ injury, prophylactic treatment to prevent swelling inathletics or sporting activities, ligamentous sprain or tendonousstrain, bursitis, joint injuries, fracture, insect bite, snake bite,insect bites, marine intoxications or envenomations due to sponges,corals, sea anemones, sea urchins, sting ray, scorpion fish, or jellyfish stings, frostbite, electrical injury, traumatic brain injury,spinal cord injury, traumatic optic neuropathy, subdural hematoma,subarachnoid hematoma, carotid cavernous fistula, stroke, myocardialinfarction, arterial obstruction, arterial laceration, extremityamputation requiring replantation, gout, angioneurotic edema, Milroy'sdisease, corneal edema, choroidal effusion, conjunctival edema,ventriculoperitoneal shunt malfunction, CSF drainage obstruction,aphthous ulcer, leukoplakia, epiglotitis, cytotoxic edema, laryngealedema, chronic cough, lichen planus, pancreatitis, polymyositis,anaphylactic shock, shock, sepsis, acute respiratory distress syndrome(ARDS), intensive care patient, heart lung bypass induced brain edema,cold induced brain edema, hepatic failure induced brain edema, highaltitude retinal hemorrhages, macular star, choroidal infarction,frosted branch angiitis, papillomas, dacryoadenitis, canaliculitis,cornea gutata, adenomas, capillary hemangioma, cavernous hemangioma,hemangioendothelioma, hemangiopericytoma, choristoma, benign reactivelymphoid hyperplasia, lymphoid neoplasia, corneal graft edema, andcorneal edema associated with refractive procedures, wherein thetherapeutic agent is selected from the group consisting of rapamycin,SDZ-RAD, tacrolimus, everolimus, pimecrolimus, CCI-779, AP23841,ABT-578, TAFA-93, RAD-001, temsirolimus, AP23573, 7-epi-rapamycin,7-thiomethyl-rapamycin, 7-epi-trimethoxyphenyl-rapamycin,7-epi-thiomethyl-rapamycin, 7-demethoxy-rapamycin,32-demethoxy-rapamycin, 2-desmethyl-rapamycin, monoester derivatives ofrapamycin, diester derivatives of rapamycin, 27-oximes of rapamycin;42-oxo analogs of rapamycin; bicyclic rapamycins; rapamycin dimers;silyl ethers of rapamycin; rapamycin arylsulfonates, rapamycinsulfamates, monoesters at positions 31 and 42, diesters at positions 31and 42, 30-demethoxy rapamycin, and pharmaceutically acceptable saltsand esters thereof.

Described herein are methods to treat, prevent, inhibit, delay onset of,or cause regression of a disease or condition comprising administeringto a subject in need thereof an effective antipermeability amount of atherapeutic agent, wherein the disease or condition is selected from thegroup consisting of retinal edema, influenza, viral encephalitis,neuroretinitis, endotoxin induced edema, vasculitis, toxic metabolicbrain edema, hemangiomas, von Hippel Lindau disease, angioneuroticedema, snake bite, high altitude cerebral edema (HACE), high altitudepulmonary edema (HAPE), pulmonary edema associated with smokeinhalation, pulmonary edema associated with anoxia, hyponatremic brainedema, edema associated with blunt trauma, brain edema following strokeor closed head injury, and corneal edema.

Described herein are methods to treat, prevent, inhibit, delay onset of,or cause regression of a disease or condition comprising administeringto a subject in need thereof an effective antipermeability amount of atherapeutic agent, wherein the therapeutic agent is administered to thesubject in need thereof at a dose of no greater than an amountequivalent to 2 mg/kg of rapamycin, and the disease or condition isselected from the group consisting of diabetic macular edema, cystoidmacular edema, macular edema from vein occlusion, congestive heartfailure, pulmonary edema, ARDS, asthma induced pulmonary edema,hemangioblastoma, pemphigous, tuberous sclerosis, edema secondary tobites or stings, Vogt-Koyanagi-Harada disease, scleritis, and exudativeretinal detachment.

In some variations the therapeutic agent is a limus compound or ananalog, derivative, salt, or ester thereof. In some variations thetherapeutic agent is an immunophilin binding compound or an analog,derivative, salt, or ester thereof. In some variations the therapeuticagent is selected from the group consisting of rapamycin, SDZ-RAD,tacrolimus, everolimus, pimecrolimus, CCI-779, AP23841, ABT-578,TAFA-93, RAD-001, temsirolimus, AP23573, 7-epi-rapamycin,7-thiomethyl-rapamycin, 7-epi-trimethoxyphenyl-rapamycin,7-epi-thiomethyl-rapamycin, 7-demethoxy-rapamycin,32-demethoxy-rapamycin, 2-desmethyl-rapamycin, monoester derivatives ofrapamycin, diester derivatives of rapamycin, 27-oximes of rapamycin;42-oxo analogs of rapamycin; bicyclic rapamycins; rapamycin dimers;silyl ethers of rapamycin; rapamycin arylsulfonates, rapamycinsulfamates, monoesters at positions 31 and 42, diesters at positions 31and 42, 30-demethoxy rapamycin, and pharmaceutically acceptable saltsand esters thereof. In some variations the therapeutic agent is selectedfrom the group consisting of rapamycin, SDZ-RAD, tacrolimus, everolimus,pimecrolimus, CCI-779, AP23841, ABT-578, and pharmaceutically acceptablesalts and esters thereof. In some variations the therapeutic agent israpamycin or a pharmaceutically acceptable salt or ester thereof. Insome variations the therapeutic agent is rapamycin.

Described herein are methods wherein the amount of the therapeutic agentadministered results in a concentration of the therapeutic agent in atissue associated with the disease or condition of no greater than anamount equivalent to 41 ng/g, no greater than an amount equivalent to 11ng/g rapamycin, or no greater than an amount equivalent to 7 ng/g ofrapamycin.

Described herein are methods wherein the therapeutic agent isadministered to the subject in need thereof at a dose of no greater thanan amount equivalent to 2 mg/kg, 0.5 mg/kg, 0.27 mg/kg, 0.07 mg/kg, or0.014 mg/kg of rapamycin.

Described herein are methods to treat a disease or condition. Describedherein are methods to prevent a disease or condition.

Described herein are methods wherein the therapeutic agent is rapamycin,and the rapamycin is administered in a formulation containing about 2%w/w rapamycin, about 4% w/w ethanol, and about 94% w/w PEG 400.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 depicts the vascular antipermeability effects of rapamycin inresponse to VEGF and various control treatments in a hamster cheek pouchmodel.

FIG. 2 depicts the vascular antipermeability effects of rapamycin inresponse to PAF and various control treatments in a hamster cheek pouchmodel. This figure shows the time course of integrated optical intensity(IOI) of fluorescein isothiocyanate-Dextran 70 (FITC-Dx 70). Afterbaseline measurements, 10⁻⁷ M PAF was applied at the time indicated bythe arrow. Rapamycin (R.) or R. vehicle was applied intraperitoneally at24 hours and again 1 hour before PAF application. Data are mean±SEM.

FIG. 3 depicts the arterial vasodilation effects of rapamycin in ahamster cheek pouch model. This figure shows the time course of relativeluminal diameter. After baseline measurements, 10⁻⁸ VEGF was applied atthe time indicated by the arrow. Rapamycin (R.) or R. vehicle wasapplied intraperitoneally at 24 hours and again 1 hour before VEGFapplication. Data are mean±SEM.

FIG. 4 depicts the arterial vasodilation effects of rapamycin in ahamster cheek pouch model. This figure shows the time course of relativeluminal diameter. After baseline measurements, 10⁻⁷ PAF was applied atthe time indicated by the arrow. Rapamycin (R.) or R. vehicle wasapplied intraperitoneally at 24 hours and again 1 hour before PAFapplication. Data are mean±SEM.

DETAILED DESCRIPTION

Described herein are formulations and methods relating to delivery oftherapeutic agents to a subject, including but not limited to a humansubject, and including but not limited to a therapeutic agent which is alimus compound, or a pharmaceutically acceptable prodrug, analog, salt,ester or derivative thereof. The formulations described herein may beused to treat, prevent, inhibit, delay onset of, or cause the regressionof the vascular permeability-related diseases or conditions, includingbut not limited to the edema- or permeability-related diseases orconditions described herein. In some variations, the formulations andmethods are used for the treatment of the aforementioned diseases orconditions.

Herein are described (1) the therapeutic agents that may be delivered toa subject, including but not limited to a human subject, (2) diseasesand conditions that may be treated, prevented, inhibited, onset delayed,or regression caused by delivery of the therapeutic agents, (3)formulations that may be used to deliver the therapeutic agents, (4)methods of treatment, (5) doses and tissue levels, (6) routes ofadministration, (7) methods of preparation, and (8) extended delivery oftherapeutic agents including but not limited to rapamycin.

Therapeutic Agents

Therapeutic agents that may be used include but are not limited tocompounds that act by binding members of the immunophilin family ofcellular proteins. Such compounds are known as “immunophilin bindingcompounds.” Immunophilin binding compounds include but are not limitedto the “limus” family of compounds. Examples of limus compounds that maybe used include but are not limited to sirolimus (rapamycin) and itswater soluble analog SDZ-RAD (Novartis), TAFA-93 (Isotechnika),tacrolimus, everolimus, RAD-001 (Novartis), pimecrolimus, temsirolimus,CCI-779 (Wyeth), AP23841 (Ariad), AP23573 (Ariad), and ABT-578 (AbbottLaboratories). Limus compound analogs and derivatives that may be usedinclude but are not limited to the compounds described in U.S. Pat. Nos.5,527,907; 6,376,517; and 6,329,386 and U.S. patent application Ser. No.09/950,307, each of which is incorporated herein by reference in theirentirety. Therapeutic agents also include analogs, prodrugs, salts,derivatives and esters of limus compounds.

In some variations the therapeutic agent is a limus compound. In somevariations the therapeutic agent is an immunophilin binding compound. Insome variations, the therapeutic agent is an mTOR inhibitor or ananalog, derivative, salt, ester or prodrug thereof (e.g., TAFA93).

In some variations the therapeutic agent is a cyclophilin or an FK-506binding protein (FKBP).

The terms rapamycin, rapa, and sirolimus are used interchangeablyherein.

Other rapamycin derivatives that may be used include, withoutlimitation, 7-epi-rapamycin, 7-thiomethyl-rapamycin,7-epi-trimethoxyphenyl-rapamycin, 7-epi-thiomethyl-rapamycin,7-demethoxy-rapamycin, 32-demethoxy-rapamycin, 2-desmethyl-rapamycin,mono- and di-ester derivatives of rapamycin, 27-oximes of rapamycin;42-oxo analog of rapamycin; bicyclic rapamycins; rapamycin dimers; silylethers of rapamycin; rapamycin arylsulfonates and sulfamates,mono-esters and di-esters at positions 31 and 42, 30-demethoxyrapamycin, and other derivatives described in Vezina et al., “Rapamycin(AY-22,989), A New Antifungal Antibiotic. I. Taxonomy Of The ProducingStreptomycete And Isolation Of The Active Principle” J. Antibiot.(Tokyo) 28:721-726 (1975); Sehgal et al., “Rapamycin (AY-22,989), A NewAntifungal Antibiotic. II. Fermentation, Isolation And Characterization”J. Antibiot. (Tokyo) 28:727-732 (1975); Sehgal et al.,“Demethoxyrapamycin (AY-24,668), A New Antifungal Antibiotic” J.Antibiot. (Tokyo) 36:351-354 (1983); and Paiva et al., “Incorporation OfAcetate, Propionate, And Methionine Into Rapamycin By Streptomyceteshygroscopicus” J Nat Prod 54:167-177 (1991), WO 92/05179, EP 467606,Caufield et al., “Hydrogenated Rapamycin Derivatives” U.S. Pat. No.5,023,262; Kao et al., “Bicyclic Rapamycins” U.S. Pat. No. 5,120,725;Kao et al., “Rapamycin Dimers” U.S. Pat. No. 5,120,727; Failli et al.,“Silyl Ethers Of Rapamycin” U.S. Pat. No. 5,120,842; Failli et al.,“Rapamycin 42-Sulfonates And 42-(N-carboalkoxy) Sulfamates Useful AsImmunosuppressive Agents” U.S. Pat. No. 5,177,203; Nicolaou et al.,“Total Synthesis Of Rapamycin” J. Am. Chem. Soc. 115: 4419-4420 (1993);Romo et al, “Total Synthesis Of (−) Rapamycin Using An Evans-TishchenkoFragment Coupling” J. Am. Chem. Soc. 115:7906-7907 (1993); and Haywardet al, “Total Synthesis Of Rapamycin Via A Novel Titanium-Mediated AldolMacrocyclization Reaction” J. Am. Chem. Soc., 115:9345-9346 (1993), eachof which is incorporated herein by reference in its entirety.

The limus family of compounds may be used in the formulations andmethods for the treatment, prevention, inhibition, delaying the onsetof, or causing the regression of the diseases and conditions describedherein.

Other therapeutic agents that may be used include those disclosed in thefollowing patents and publications, the contents of each of which isincorporated herein by reference in its entirety: PCT publication WO2004/027027, published Apr. 1, 2004, titled Method of inhibitingchoroidal neovascularization, assigned to Trustees of the University ofPennsylvania; U.S. Pat. No. 5,387,589, issued Feb. 7, 1995, titledMethod of Treating Ocular Inflammation, with inventor Prassad Kulkarni,assigned to University of Louisville Research Foundation; U.S. Pat. No.6,376,517, issued Apr. 23, 2003, titled Pipecolic acid derivatives forvision and memory disorders, assigned to GPI NIL Holdings, Inc; U.S.Pat. No. 5,100,899; U.S. Pat. No. 4,316,885, U.S. Pat. No. 4,650,803; USpublication 2005/0032826, U.S. Pat. No. 6,890,546, and PCT publicationWO 99/22722.

In some variations the formulation comprises a combination of one ormore therapeutic agents.

The therapeutic agents may also be used in combination with othertherapeutic agents and therapies, including but not limited to agentsand therapies useful for the treatment, prevention, inhibition, delayingonset of, or causing regression of the diseases or conditions describedherein.

Diseases or Conditions that May be Treated, Prevented, Inhibited, OnsetDelayed, or Regression Caused

Herein are described nonlimiting examples of diseases and conditionsthat may be treated, prevented, inhibited, onset delayed, or regressioncaused using the formulations and methods described herein. In somevariations, the diseases or conditions are treated using one or more ofthe formulations or methods described herein. In some variations, thediseases or conditions are prevented using one or more of theformulations or methods described herein. In some variations, thediseases or conditions are inhibited using one or more of theformulations or methods described herein. In some variations, onset ofthe diseases or conditions is delayed using one or more of theformulations or methods described herein. In some variations, regressionof the diseases or conditions is caused using one or more of theformulations or methods described herein. In some variations a diseaseor condition in a subject is treated, prevented, inhibited, onsetdelayed, or regression caused by administering to a subject in needthereof a formulation comprising a therapeutically effective amount ofone or more therapeutic agents described herein. Unless the contextindicates otherwise, the subjects on whom all of the methods oftreatment may be performed include, but are not limited to, humansubjects.

Generally, any vascular permeability related diseases or conditionssusceptible to treatment, prevention, inhibition, delaying the onset of,or regression using the formulations and methods described herein may betreated, prevented, inhibited, onset delayed, or regression caused usingthe formulations and methods described herein. In some variations, thevascular permeability-related disease or condition is an ocular diseaseor condition.

Generally, any diseases or conditions relating to vasodilationsusceptible to treatment, prevention, inhibition, delaying the onset of,or regression using the formulations and methods described herein may betreated, prevented, inhibited, onset delayed, or regression caused usingthe formulations and methods described herein. In some variations thediseases or conditions relating to vasodilation are permeability relateddiseases or conditions. In some variations, the vasodilation-relateddisease or condition is an ocular disease or condition.

In some variations, the vascular permeability related diseases orconditions are edema related diseases or conditions. In some variations,the edema related disease or condition is an ocular disease orcondition.

In some variations, the formulations described herein are used to treat,prevent, inhibit, delay onset of, or cause regression of one or more ofa vascular permeability-associated disease or disorder. In somevariations, the formulations described herein are used to treat one ormore of edema associated with capillary leak, diseases with edema as acomplication, edema associated with endothelial cell dysfunction, edemaassociated with venous obstruction, edema associated with lymphaticobstruction, edema associated with pulmonary disease, edema associatedwith infectious conditions, edema associated with inflammatory,noninfectious, or autoimmune conditions, edema associated withneurologic conditions, edema associated with neoplasms or tumors (benignor malignant, solid or non-solid), diseases with dermatologicassociations or findings, edema associated with genetic, congenital, orcystic abnormalities, edema due to environment, edema caused by injury,edema associated with infarction and ischemia reperfusion, miscellaneouscauses of edema, or edema associated with systemic conditions. In somevariations, the methods or formulations described herein are used totreat edema associated with neoplasms.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with edema correlated withcapillary leak. In some variations the disease or condition associatedwith edema associated with capillary leak is any one or more ofcardiomyopathy, dilated cardiomyopathy, hypertrophic cardiomyopathy,restrictive cardiomyopathy, congestive heart failure, filariasis, kidneyfailure, lymphedema, preeclampsia, eclampsia, thyroid condition,varicosity, or varicose veins. In some variations, the methods orformulations described herein are used to treat congestive heartfailure.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with edema as acomplication. In some variations the disease or condition associatedwith edema as a complication is any one or more of aortic coarcation,cor pulmonale, exudative dermatitis, Hodgkin's disease, pericarditis, ornephrogenic pulmonary edema.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with edema correlated withvenous obstruction. In some variations the disease or conditionassociated with edema correlated with venous obstruction is any one ormore of thrombophlebitis, thrombosis, neoplasm, varicosity, varicoseveins, arteriovenous fistula, lymph node mass, or aneurysm.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with edema correlated withlymphatic obstruction. In some variations the disease or conditionassociated with edema correlated with lymphatic obstruction isfilariasis, cellulitis, neoplasm, or surgical excision. In somevariations, the methods or formulations described herein are used totreat cellulitis.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with edema correlated withpulmonary disease. In some variations the disease or conditionassociated with edema correlated with pulmonary disease is pulmonaryedema, chronic obstructive pulmonary disease, pleural effusion,aspiration pneumonitis, asthma induced edema, or amniotic fluidembolism. In some variations, the methods or formulations describedherein are used to treat pulmonary edema. In some variations, themethods or formulations described herein are used to treat asthmainduced pulmonary edema.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with edema correlated withinfectious diseases or conditions. In some variations the disease orcondition associated with edema correlated with infectious diseases orconditions is boils, carbuncle, abscess, erysipelas, osteomyelitis, gasgangrene, erysipelas, anthrax, Ludwig's angina, parasitic infections,trichinosis, viral encephalitis, AIDS, herpes simplex virus infection,herpes zoster virus infection, tuberculosis (disseminated, military,etc.), neurosyphilis, prion diseases, meningitis, pneumococcalmeningitis, rabies, neuroretinitis, anthrax exposure, or endotoxininduced edema. In some variations, the methods or formulations describedherein are used to treat viral encephalitis. In some variations, themethods or formulations described herein are used to treat herpessimplex virus infection. In some variations, the methods or formulationsdescribed herein are used to treat herpes zoster virus infection. Insome variations, the methods or formulations described herein are usedto treat tuberculosis. In some variations, the methods or formulationsdescribed herein are used to treat neurosyphilis. In some variations,the methods or formulations described herein are used to treatneuroretinitis. In some variations, the methods or formulationsdescribed herein are used to treat endotoxin induced edema.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with edema correlated withinflammatory, noninfectious, or autoimmune diseases or conditions. Insome variations the disease or condition associated with edemacorrelated with inflammatory, noninfectious, or autoimmune diseases orconditions is Wegeners granulomatosis, Sjogren's syndrome, scleroderma,systemic Lupus erythematosis, sarcoidosis, multiple sclerosis, Reiter'ssyndrome, Pyogenic granuloma, vasculitis, or demyelinating diseases. Insome variations, the methods or formulations described herein are usedto treat Reiter's syndrome. In some variations, the methods orformulations described herein are used to treat Pyogenic granuloma. Insome variations, the methods or formulations described herein are usedto treat systemic Lupus erythematosis. In some variations, the methodsor formulations described herein are used to treat scleroderma. In somevariations, the methods or formulations described herein are used totreat sarcoidosis. In some variations, the methods or formulationsdescribed herein are used to treat Wegeners granulomatosis. In somevariations, the methods or formulations described herein are used totreat Sjogren's syndrome. In some variations, the methods orformulations described herein are used to treat multiple sclerosis. Insome variations, the methods or formulations described herein are usedto treat vasculitis. In some variations, the methods or formulationsdescribed herein are used to treat demyelinating disease. In somevariations, the methods or formulations described herein are used totreat toxic metabolic brain edema. In some variations, the methods orformulations described herein are used to treat arthritis. In somevariations, the arthritis is rheumatoid arthritis. In some variations,the arthritis is osteoarthritis. In some variations, the methods orformulations described herein are used to treat carpel tunnel syndrome.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with edema correlated witha neurological disease or condition. In some variations the disease orcondition associated with edema correlated with a neurological diseaseor condition is benign intracranial hypertension, papilledema, opticneuritis, multi-infarct dementia, Alzheimers disease, amyloid depositiondiseases, toxic metabolic brain edema, cerebral amyloid angiopathy (alsoknown as congophilic angiopathy or cerebrovascular amyloidosis),post-ictal state, blood brain barrier dysfunction, Vogt-Koyanagi-Haradasyndrome, prophylactic use in carotid endarterectomy, or vasogenic brainedema. In some variations, the methods or formulations described hereinare used to treat papilledema. In some variations, the methods orformulations described herein are used to treat optic neuritis. In somevariations, the methods or formulations described herein are used totreat amyloid deposition diseases. In some variations, the methods orformulations described herein are used to treat Vogt-Koyanagi-Haradasyndrome.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with edema correlated witha solid or non-solid, benign or malignant, neoplasm or tumor. In somevariations the disease or condition associated with edema correlatedwith a solid or non-solid, benign or malignant, neoplasm or tumor ischoroidal melanoma, choroidal nevus, melanoma, neuroma, epithelioma,lymphangioma, myxoma, fibroma, fibromyoma, osteoma, chondroma, angioma,angiosarcoma, peritumoral brain edema, hemangiomas, carcinoid, ormultiple endocrine neoplasia. In some variations, the methods orformulations described herein are used to treat choroidal melanoma. Insome variations, the methods or formulations described herein are usedto treat choroidal nevus. In some variations, the methods orformulations described herein are used to treat melanoma. In somevariations, the methods or formulations described herein are used totreat neuroma. In some variations, the methods or formulations describedherein are used to treat epithelioma. In some variations, the methods orformulations described herein are used to treat lymphangioma. In somevariations, the methods or formulations described herein are used totreat myxoma. In some variations, the methods or formulations describedherein are used to treat fibroma. In some variations, the methods orformulations described herein are used to treat fibromyoma. In somevariations, the methods or formulations described herein are used totreat osteoma. In some variations, the methods or formulations describedherein are used to treat chondroma. In some variations, the methods orformulations described herein are used to treat hemangioma. In somevariations, the methods or formulations described herein are used totreat hemangioblastoma.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with a dermatologicaldisease or disorder. In some variations the disease or conditionassociated with edema correlated with a dermatological disease ordisorder is porphyria cutanea tarda, pemphigoid, dermatitisherpetiformis, pemphigous, empitigo, erythema multiforme, exudativedermatitis, epidermolysis bullosa, contact dermatitis, actinicdermatitis, toxic erythema, dermatomyositis, eczema, or toxic epidermalnecrolysis. In some variations, the methods or formulations describedherein are used to treat dermatitis. In some variations, the methods orformulations described herein are used to treat pemphigous. In somevariations, the methods or formulations described herein are used totreat erythema multiforme.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with a genetic,congenital, or cystic abnormality. In some variations the disease orcondition associated with edema correlated with a genetic, congenital,or cystic abnormality is xeroderma pigmentosa, hydrocoele, dermoid cyst,ovarian cyst, amniotic band, arteriovenous fistula, meningocoele,hydrocephalus, hereditary angioneurotic edema, neurofibromatosis, VonHippel Lindau disease, or tuberous sclerosis. In some variations, themethods or formulations described herein are used to treatneurofibromatosis. In some variations, the methods or formulationsdescribed herein are used to treat Von Hippel Lindau disease. In somevariations, the methods or formulations described herein are used totreat tuberous sclerosis.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with increased capillarypermeability. In some variations the disease or condition associatedwith edema correlated with increased capillary permeability is acutenephritis, angioneurotic edema, scleroderma, hypersensitivity reactions,or transfusion reactions. In some variations, the methods orformulations described herein are used to treat hypersensitivityreactions. In some variations, the methods or formulations describedherein are used to treat angioneurotic edema.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with edema correlated withan environmental or other exposure. In some variations the disease orcondition associated with edema correlated with an environmental orother exposure is acute mountain sickness, high altitude pulmonary edema(HAPE), high altitude cerebral edema (HACE), tropical edema, chilblains,drug toxicity, poisonings, anoxia (by way of nonlimiting example, smokeinhalation, carbon monoxide poisoning, near drowning, etc.), exposure tonoxious gases, poison ivy, poison oak, poison sumac, or nettlesexposure, cholinergic intoxication, edema from systemic steroid therapy,ethanol induced brain injury, or hyponatremic brain edema. In somevariations, the methods or formulations described herein are used totreat drug toxicity. In some variations, the methods or formulationsdescribed herein are used to treat high altitude pulmonary edema (HAPE).In some variations, the methods or formulations described herein areused to treat high altitude cerebral edema (HACE). In some variations,the methods or formulations described herein are used to treat pulmonaryedema associated with anoxia. In some variations, the methods orformulations described herein are used to treat pulmonary edemaassociated with smoke inhalation. In some variations, the methods orformulations described herein are used to treat hyponatremic brainedema.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with edema correlated withtrauma or injury. In some variations the disease or condition associatedwith edema correlated with trauma or injury is acute trauma (by way ofnon limiting example from bone, joint, soft tissue, or organ injury),prophylactic to prevent swelling in athletics or sporting activities,bruise, contusion, ligamentous sprain or tendonous strain, bursitis,joint injuries, fracture, insect bite, snake bite, marine intoxicationsor envenomations (by way of nonlimiting example from sponges, corals,sea anemones, sea urchins, sting ray, scorpion fish, jelly fish stings,etc.), exposure to an irritant or corrosive, frostbite, burn, sunburn,electrical injury, traumatic brain injury, spinal cord injury, traumaticoptic neuropathy, subdural hematoma, subarachnoid hematoma, or carotidcavernous fistula. In some variations, the methods or formulationsdescribed herein are used to treat acute trauma. In some variations, themethods or formulations described herein are used to treat edemasecondary to bites or stings. In some variations, the methods orformulations described herein are used to treat edema associated withblunt trauma. In some variations, the methods or formulations describedherein are used to treat insect bite. In some variations, the methods orformulations described herein can be used to treat snake bites. In somevariations, the methods or formulations described herein are used totreat burn. In some variations, the methods or formulations describedherein are used to treat traumatic optic neuropathy. In some variations,the methods or formulations described herein are used to treat carotidcavernous fistula.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with edema correlated withinfarction or ischemia reperfusion. In some variations the disease orcondition associated with edema correlated with infarction or ischemiareperfusion is stroke, myocardial infarction, arterial obstruction,arterial laceration, extremity amputation requiring replantation,central retinal artery occlusion, branch retinal artery occlusion,anterior or posterior ischemic optic neuropathy, or ischemia inducededema. In some variations, the methods or formulations described hereinare used to treat central retinal artery occlusion. In some variations,the methods or formulations described herein are used to treat branchretinal artery occlusion. In some variations, the methods orformulations described herein are used to treat anterior or posteriorischemic optic neuropathy. In some variations, the methods orformulations described herein are used to treat ischemia induced edema.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with edema due to one ormore miscellaneous causes. In some variations the disease or conditionassociated with edema due to one or more miscellaneous causes is gout,angioneurotic edema, Milroy's disease, corneal edema, episceritis,scleritis, choroidal effusion, conjunctival edema, exudative retinaldetachment, ventriculoperitoneal shunt malfunction, CSF drainageobstruction, aphthous ulcer, leukoplakia, epiglotitis, cytotoxic edema,laryngeal edema, chronic cough, lichen planus, pancreatitis,blepharitis, eyelid swelling, or polymyositis. In some variations, themethods or formulations described herein are used to treat eyelid edema.In some variations, the methods or formulations described herein areused to treat corneal edema. In some variations, the corneal edema ischronic corneal edema. In some variations, the methods or formulationsdescribed herein are used to treat episceritis. In some variations, themethods or formulations described herein are used to treat scleritis. Insome variations, the methods or formulations described herein are usedto treat choroidal effusion. In some variations, the methods orformulations described herein are used to treat conjunctival edema. Insome variations, the methods or formulations described herein are usedto treat exudative retinal detachment. In some variations, the methodsor formulations described herein are used to treat ventriculoperitonealshunt malfunction. In some variations, the methods or formulationsdescribed herein are used to treat blepharitis. In some variations, themethods or formulations described herein are used to treat eyelidswelling. In some variations, the methods or formulations describedherein are used to treat CSF drainage obstruction.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofone or more diseases or conditions associated with edema due to one ormore systemic diseases or conditions. In some variations the disease orcondition associated with edema due to one or more systemic diseases orconditions is anaphylactic shock, shock, sepsis, acute respiratorydistress syndrome (ARDS), intensive care patient, heart lung bypassinduced brain edema, cold induced brain edema, or hepatic failureinduced brain edema. In some variations, the methods or formulationsdescribed herein are used to treat acute respiratory distress syndrome(ARDS). In some variations, the methods or formulations described hereinare used to treat brain edema following stroke. In some variations, themethods or formulations described herein are used to treat brain edemafollowing closed head injury.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofinfluenza. In some variations, the influenza is bird flu. In somevariations, the influenza is influenza A, influenza B, or influenza C.In some variations, the influenza is influenza A (H3), influenza A (H1),influenza A (H1N2), influenza A (H3N2), influenza A/Panama/2007/99(H3N2), influenza A/Fujian/411/2002 (H3N2), or influenza A (H5N1).

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofmacular edema. In some variations, the macular edema is diabetic macularedema. In some variations, the macular edema is macular edema from veinocclusion.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofcystoid macular edema.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofretinal artery occlusion. In some variations, the methods orformulations described herein are used to treat, prevent, inhibit, delayonset of, or cause regression of retinal vein occlusion.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofcentral retinal artery occlusion. In some variations, the methods orformulations described herein are used to treat, prevent, inhibit, delayonset of, or cause regression of central retinal vein occlusion.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofbranch retinal artery occlusion. In some variations, the methods orformulations described herein are used to treat, prevent, inhibit, delayonset of, or cause regression of branch retinal vein occlusion.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofexudative retinal detachment.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofretinal edema associated with choroidal neovascularization.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofchoroidal effusion.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofsympathetic ophthalmia, sarcoma, high altitude retinal hemorrhages,blunt and penetrating ocular and orbital trauma, hypertensiveretinopathy, macular star, orbital cellulitis, choroidal infarction,frosted branch angiitis, sickle cell disease, papillomas, keratitis,dacryoadenitis, canaliculitis, dacryocystitis, contact lens inducedconjunctivitis, interstitial keratitis, ligneous conjunctivitis,pinguecula, pterygium, cornea gutata, adenomas, capillary hemangioma,cavernous hemangioma, hemangioendothelioma, hemangiopericytoma, kaposi'ssarcoma, choristoma, benign reactive lymphoid hyperplasia, lymphoidneoplasia, hordeolum, chalazion, xanthomatous tumors, corneal graftedema, corneal edema associated with refractive procedures, and ptosis.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofage-related macular degeneration (e.g., wet age-related maculardegeneration or dry to wet age-related macular degeneration), diabeticretinopathy, retinopathy of prematurity, central retinal vein occlusion,branch retinal vein occlusion, or uveitis.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofmacular edema (e.g., diabetic macular edema, cystoid macular edema, ormacular edema from vein occlusion), retinal edema (e.g., retinal edemaassociated with choroidal neovascularization), influenza including birdflu, congestive heart failure, pulmonary edema, ARDS, asthma inducedpulmonary edema, viral encephalitis, neuroretinitis, endotoxin inducededema, vasculitis, toxic metabolic brain edema, Vogt-Koyanagi-Haradadisease, hemangiomas, hemangioblastoma, pemphigous; von Hippel Lindaudisease, tuberous sclerosis, angioneurotic edema, snake bite, highaltitude cerebral edema (HACE), high altitude pulmonary edema (HAPE),pulmonary edema associated with smoke inhalation, pulmonary edemaassociated with anoxia, hyponatremic brain edema, edema associated withblunt trauma, edema secondary to bites or stings, brain edema followingstroke or closed head injury, exudative retinal detachment, cornealedema (e.g. chronic corneal edema), or scleritis.

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofcystoid macular edema, retinal edema (e.g., retinal edema associatedwith choroidal neovascularization), influenza including bird flu, viralencephalitis, neuroretinitis, endotoxin induced edema, vasculitis, toxicmetabolic brain edema, hemangioma, angioneurotic edema, snake bite, highaltitude cerebral edema (HACE), high altitude pulmonary edema (HAPE),hyponatremic brain edema, edema associated with blunt trauma, brainedema following stroke or closed head injury, or corneal edema (e.g.chronic corneal edema).

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofmacular edema, retinal edema, Vogt-Koyanagi-Harada disease, von HippelLindau disease, retinal detachment (e.g., exudative retinal detachment)or corneal edema (e.g. chronic corneal edema).

In some variations, the methods or formulations described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofhypotension due to peripheral vasodilation. In some variations, themethods or formulations described herein are used to treat, prevent,inhibit, delay onset of, or cause regression of aortic stenosis. In somevariations, the methods or formulations described herein are used totreat a disease or disorder which is detrimental to a subject withaortic stenosis. In some variations, the methods or formulationsdescribed herein are used to treat a permeability-related disease ordisorder which is detrimental to a subject with aortic stenosis.

In some variations any one or more of the formulations described hereincomprising any one or more of the therapeutic agents described hereinare used to treat, prevent, inhibit, delay onset of, or cause regressionof any vascular permeability related disease or disorder, including butnot limited to those vascular permeability related diseases or disordersdescribed herein.

In some variations any one or more of the formulations described hereincomprising any one or more of the therapeutic agents described hereinare used to treat, prevent, inhibit, delay onset of, or cause regressionof any vasodilation related disease or disorder, including but notlimited to those vascular permeability related diseases or disordersdescribed herein.

In some variations any one or more of the formulations described in U.S.60/772,018, titled STABLE FORMULATIONS AND METHODS OF THEIR PREPARATIONAND USE; U.S. Ser. No. 11/386,290, titled DRUG DELIVERY SYSTEMS FORTREATMENT OF DISEASES OR CONDITIONS; U.S. Ser. No. 11/351,844, titledFORMULATIONS FOR OCULAR TREATMENT; U.S. Ser. No. 11/351,761, titledLIQUID FORMULATIONS FOR TREATMENT OF DISEASES OR CONDITIONS; U.S. Ser.No. 11/386,290, titled DRUG DELIVERY SYSTEMS FOR TREATMENT OF DISEASESOR CONDITIONS; and US 2005/0064010 are used to treat, prevent, inhibit,delay onset of, or cause regression of any vascular permeability relateddisease or disorder, including but not limited to those vascularpermeability related diseases or disorders described herein.

In some variations any one or more of the therapeutic agents describedherein are used to treat, prevent, inhibit, delay onset of, or causeregression of any vascular permeability related disease or disorder,excepting those vascular permeability related diseases or disordersdescribed in PCT publication WO 04/027027, U.S. Pat. No. 6,376,517, USpublication number 2005/0064010, or U.S. Pat. No. 5,387,589, thecontents of each of which is hereby incorporated by reference in itsentirety.

In some variations any of the therapeutic agents described herein areused to treat, prevent, inhibit, delay onset of, or cause regression ofany vascular permeability related disease or disorder, excepting thosevascular permeability related diseases or disorders described in PCTpublication WO 04/027027, U.S. Pat. No. 6,376,517, or U.S. Pat. No.5,387,589.

In some variations, any one or more of the therapeutic agents orformulations described herein are used to treat, prevent, inhibit, delayonset of, or cause regression of any one or more of cardiomyopathy,dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictivecardiomyopathy, congestive heart failure, filariasis, kidney failure,lymphedema, preeclampsia, eclampsia, thyroid condition, varicosity,varicose veins, aortic coarcation, cor pulmonale, exudative dermatitis,Hodgkin's disease, pericarditis, nephrogenic pulmonary edema,varicosity, arteriovenous fistula, lymph node mass, aneurysm,filariasis, neoplasm, surgical excision, pulmonary edema, chronicobstructive pulmonary disease, pleural effusion, aspiration pneumonitis,asthma induced edema, amniotic fluid embolism, boils, carbuncle,abscess, erysipelas, osteomyelitis, gas gangrene, erysipelas, anthrax,Ludwig's angina, parasitic infections, trichinosis, viral encephalitis,AIDS, herpes simplex virus infection, prion diseases, rabies,neuroretinitis, anthrax exposure, endotoxin induced edema, Wegenersgranulomatosis, Sjogren's syndrome, scleroderma, systemic Lupuserythematosis, multiple sclerosis, Pyogenic granuloma, vasculitis,demyelinating diseases, benign intracranial hypertension, multi-infarctdementia, Alzheimers disease, amyloid deposition diseases, toxicmetabolic brain edema, cerebral amyloid angiopathy, post-ictal state,blood brain barrier dysfunction, prophylactic use in carotidendarterectomy, vasogenic brain edema, choroidal nevus, neuroma,epithelioma, lymphangioma, myxoma, fibroma, fibromyoma, osteoma,chondroma, angioma, angiosarcoma, peritumoral brain edema, hemangiomas,carcinoid, multiple endocrine neoplasia, porphyria cutanea tarda,pemphigoid, dermatitis herpetiformis, pemphigous, empitigo, erythemamultiforme, exudative dermatitis, epidermolysis bullosa, contactdermatitis, actinic dermatitis, toxic erythema, dermatomyositis, eczema,toxic epidermal necrolysis, xeroderma pigmentosa, hydrocoele, dermoidcyst, ovarian cyst, amniotic band, arteriovenous fistula, meningocoele,hydrocephalus, hereditary angioneurotic edema, neurofibromatosis, VonHippel Lindau disease, tuberous sclerosis, acute nephritis,angioneurotic edema, scleroderma, hypersensitivity reactions,transfusion reactions, acute mountain sickness, high altitude pulmonaryedema (HAPE), high altitude cerebral edema (HACE), tropical edema,chilblains, drug toxicity, poisonings, anoxia due to smoke inhalation,carbon monoxide poisoning, or near drowning, exposure to noxious gases,poison ivy, poison oak, poison sumac, or nettles exposure, cholinergicintoxication, edema from systemic steroid therapy, ethanol induced braininjury, hyponatremic brain edema, acute trauma from bone, joint, softtissue, or organ injury, prophylactic treatment to prevent swelling inathletics or sporting activities, ligamentous sprain or tendonousstrain, bursitis, joint injuries, fracture, insect bite, snake bite,marine intoxications or envenomations due to sponges, corals, seaanemones, sea urchins, sting ray, scorpion fish, or jelly fish stings,frostbite, electrical injury, traumatic brain injury, spinal cordinjury, traumatic optic neuropathy, subdural hematoma, subarachnoidhematoma, carotid cavernous fistula, stroke, myocardial infarction,arterial obstruction, arterial laceration, extremity amputationrequiring replantation, gout, angioneurotic edema, Milroy's disease,corneal edema, choroidal effusion, conjunctival edema,ventriculoperitoneal shunt malfunction, CSF drainage obstruction,aphthous ulcer, leukoplakia, epiglotitis, cytotoxic edema, laryngealedema, chronic cough, lichen planus, pancreatitis, polymyositis,anaphylactic shock, shock, sepsis, acute respiratory distress syndrome(ARDS), intensive care patient, heart lung bypass induced brain edema,cold induced brain edema, hepatic failure induced brain edema, highaltitude retinal hemorrhages, macular star, choroidal infarction,frosted branch angiitis, papillomas, dacryoadenitis, canaliculitis,cornea gutata, adenomas, capillary hemangioma, cavernous hemangioma,hemangioendothelioma, hemangiopericytoma, choristoma, benign reactivelymphoid hyperplasia, lymphoid neoplasia, corneal graft edema, cornealedema associated with refractive procedures, arthritis (e.g., rheumatoidarthritis or osteoarthritis), and carpel tunnel syndrome.

Formulations

Most generally, the formulations described herein comprise any one ormore of the therapeutic agents described herein and may generally be ofany type that is capable of delivering the therapeutic agent fortreating, preventing, inhibiting, delaying onset of, or causingregression of one or more of the diseases or conditions describedherein. In some variations the therapeutic agent is a limus compound, ora pharmaceutically acceptable prodrug, analog, salt, ester or derivativethereof.

In some variations any of the formulations described herein areadministered in multiple locations within a period of time, includingwithout limitation within an hour of one another. Without being bound bytheory, it is thought that such multiple administrations, including butnot limited to multiple injections, allow for a greater total dose to beadministered to the tissue than a single dose due to a potentiallylimited ability of the local tissue to absorb the larger volume oramount. In some variations any of the formulations described herein areadministered at one or more times.

In some variations the formulation is a solid formulation, a liquidformulation, a drug delivery system, or a formulation associated,delivered by, or administered proximate to a device.

In some variations, the formulation is a nanoparticle formulation. Insome variations, the nanoparticle formulation is made by milling.

In some variations the formulation is a stable formulation of rapamycinprepared or preparable by a method described in U.S. 60/772,018, filedFeb. 9, 2006, titled STABLE FORMULATIONS AND METHODS OF THEIRPREPARATION AND USE.

Solid Formulations

In some variations the formulations described herein are solidformulations. The solid formulations may be formulated for variousroutes of administration, including but not limited to delivery by anyroute of administration described herein, including but not limited toby implantation or oral delivery. Nonlimiting examples of solid dosageforms include controlled or sustained release formulations, coated oruncoated solid formulations, wafers, films, particles, microparticles,nanoparticles, beads, diffusion-based formulations, degradation-basedformulations, formulations with a reservoir, chewable formulations,rapidly disintegrating formulations, buccal formulations, andpolymer-based formulations.

In some variations, the therapeutic agent is administered as a solidformulation, including but not limited to solid a formulation consistingessentially of pure drug (e.g., about 99% w/w).

Non-limiting examples of solid drug delivery systems that may be used inthe methods described herein are found in U.S. 60/664,119, titled DRUGDELIVERY SYSTEMS FOR TREATMENT OF DISEASES OR CONDITIONS and U.S. Ser.No. 11/386,290, titled DRUG DELIVERY SYSTEMS FOR TREATMENT OF DISEASESOR CONDITIONS, each of which is incorporated herein by reference in itsentirety.

Liquid Formulations

In some variations the formulations described herein are liquidformulations. The liquid formulations described herein contain atherapeutic agent and may generally be any liquid formulation, includingbut not limited to solutions, suspensions, and emulsions.

One liquid formulation described herein is an in situ gellingformulation. In situ gelling formulations, as described herein, comprisea therapeutic agent and a plurality of polymers which give a formulationthat forms a gel or a gel-like substance when placed in an aqueousmedium, including but not limited to an aqueous medium of the eye.

In some variations of the liquid formulations described herein, thetherapeutic agent is a solution or suspension of rapamycin in a liquidmedium. Liquid media include but are not limited to solvents, includingbut not limited to those in the Solubilization of Therapeutic Agentssection.

The liquid formulations described herein may comprise a solubilizingagent component. In some variations the solubilizing agent component isa surfactant. Note that there is some overlap between components thatmay be solvents and solubilizing agents, and therefore the samecomponent may in some systems be used as either a solvent or asolubilizing agent. A liquid formulation that comprises a therapeuticagent and a component that may be considered either a solvent or asolubilizing agent or surfactant will be considered a solvent if it isplaying the role of a solvent; if the component is not playing the roleof the solvent, the component may be considered a solubilizing agent orsurfactant.

Liquid formulations may optionally further comprise stabilizers,excipients, gelling agents, adjuvants, antioxidants, and/or othercomponents as described herein.

In some variations all components in the liquid formulation, other thanthe therapeutic agent, are liquid at room temperature.

In some variations, the liquid formulation comprises nanoparticles. Insome variations, the nanoparticles are made by milling.

In some variations, the liquid formulation comprises a release modifyingagent. In some variations, the release modifying agent is a film-formingpolymer component. The film-forming polymer component may comprise oneor more film-forming polymers. Any film-forming polymer may be used inthe excipient component. In some variations, the film-forming polymercomponent comprises a water insoluble film forming polymer. In somevariations, the release modifying agent component comprises an acrylicpolymer, including but not limited to polymethacrylate, including butnot limited to Eudragit RL.

Described herein are compositions and liquid formulations for deliveryof the therapeutic agents described in the Therapeutic Agents section.Delivery of therapeutic agents using the compositions and liquidformulations described herein may be used to treat, prevent, inhibit,delay the onset of, or cause the regression of the diseases andconditions described in the Diseases and Conditions section. Thecompositions and liquid formulations described herein may comprise anyof the therapeutic agents described in the Therapeutic Agents section,including but not limited to rapamycin. The compositions and liquidformulations described herein may comprise one or more than onetherapeutic agent. Other compositions and liquid formulations inaddition to those explicitly described herein may be used.

When the therapeutic agent is rapamycin, the formulations may be used tomaintain an amount of a therapeutic agent described herein, includingbut not limited to a limus compound such as rapamycin that is effectiveto treat one or more of the diseases or conditions described herein.

In some variations the therapeutic agent in the formulation comprisesbetween 0.01 to 80% of the total weight of the composition; between 0.05to 15%; between 0.1 to 10%; between 1 to 5%; or between 5 to 15%;between 8 to 10%; between about 0.01 to about 1%; between 0.05 to 5%;between 0.1 to 0.2%; between 0.2 to 0.3%; between 0.3 to 0.4%; between0.4 to 0.5%; between 0.5 to 0.6%; between 0.6 to 0.7%; between 0.7 to1%; between 1 to 5%; between 5 to 10%; between 5 to 30%; between 15 to55%, between 20 to 30%; between 25 to 30%, between 35 to 55%; about 10%;about 20%, about 30%, about 35%, about 40%; about 45%; about 50%; about55%, about 60%, about 65%; about 70%, about 75%; or about 80% w/w.

The solvent component may comprise, for instance, between about 0.01 toabout 99.9% of the total weight of the composition; between about 0.1 toabout 99%; between about 25 to about 55%; between about 30 to about 50%;or between about 35 to about 45%; between about 0.1 to about 10%;between about 10 to about 20%; between about 20 to about 30%; betweenabout 30 to about 40%; between about 40 to about 45%; between about 40to about 45%; between about 45 to about 50%; between about 50 to about60%; between about 50 to about 70%; between about 70 to about 80%;between about 80 to about 90%; or between about 90 to about 100%.

The solubilizing agent component may comprise, for instance, betweenabout 0.01 to about 30% of the total weight of the composition; betweenabout 0.1 to about 20%; between about 2.5 to about 15%; between about 10to about 15%; or between about 5 to about 10%; between about 8 to about12%; between about 10 to about 20%; between about 20 to about 30%.

In some variations, the liquid formulations described herein have aviscosity of between 40% and 120% centipoise. In some variations theliquid formulations described herein have a viscosity of between 60% and80% centipoise.

In some variations the liquid formulations described herein comprise atherapeutic agent and a solvent component. The solvent component maycomprise a single solvent or a combination of solvents. The therapeuticagent component may comprise a single therapeutic agent or a combinationof therapeutic agents. In some variations, the solvent is glycerin,dimethylsulfoxide, N-methylpyrrolidone, dimethyl acetamide (DMA),dimethyl formamide, glycerol formal, ethoxy diglycol, triethylene glycoldimethyl ether, triacetin, diacetin, corn oil, acetyl triethyl citrate(ATC), ethyl lactate, polyglycolated capryl glyceride, γ butyrolactone,dimethyl isosorbide, benzyl alcohol, ethanol, isopropyl alcohol,polyethylene glycol of various molecular weights, including but notlimited to PEG 300 and PEG 400, or propylene glycol, or a mixture of oneor more thereof.

In some variations the liquid formulations described herein aresolutions, and comprise a therapeutic agent and a solvent component. Insome variations the solvent component comprises ethanol. In somevariations the solvent component comprises ethanol and a polyethyleneglycol, including but not limited to a liquid polyethylene glycol,including but not limited to one or more of PEG 300 or PEG 400.

In some variations, the liquid formulations described herein aresuspensions, and comprise a therapeutic agent and a diluent component.In some variations, the diluent component comprises one or morecomponents listed herein as solvents or solubilizing agents, wherein theresulting mixture is a suspension.

In some variations the liquid formulation is partly a solution andpartly a suspension.

In some variations the liquid formulation is an in situ gellingformulation, and comprises a therapeutic agent and a polymer component,wherein the polymer component may comprise a plurality of polymers. Insome variations, the liquid formulation comprises a polymethacrylatepolymer. In some variations, the liquid formulation comprises apolyvinylpyrrolidone polymer.

Some variations of liquid formulations include one or more therapeuticagent or agents such as but not limited to rapamycin between about 0.01%and about 20% by weight of the total, a solvent between about 5% andabout 15% by weight of the total, a solubilizing agent including but notlimited to a surfactant between about 5% and about 15% by weight of thetotal, with water as the primary remaining component. In some variationsthe formulations further comprise stabilizing agents, excipients,adjuvants, or antioxidants, between about 0 and about 40% by weight ofthe total.

In some variations, a liquid formulation comprises up to about 5%therapeutic agent, including but not limited to rapamycin, per weight ofthe total; and up to about 99.9% of a solvent component, by weight ofthe total. In some variations the liquid formulation comprises up toabout 5% therapeutic agent, including but not limited to rapamycin, perweight of the total; and up to about 99.9% of a diluent component.

In some variations, a liquid formulation may comprise up to about 5%therapeutic agent, including but not limited to rapamycin, per weight ofthe total; up to about 10% solvent by weight of the total; and up toabout 85% of a solubilizing component, by weight of the total. In somevariations the solubilizing component is an aqueous solution of asurfactant.

A plurality of polymers component may comprise, for instance, betweenabout 0.01 to about 30% of the total weight of the composition; betweenabout 0.1 to about 20%; between about 2.5 to about 15%; between about 10to about 15%; between about 3 to about 5%; between about 5 to about 10%;between about 8 to about 12%; between about 10 to about 20%; or betweenabout 20 to about 30%.

Some variations of liquid formulations includes a therapeutic agent oragents such as but not limited to rapamycin between about 0.01% andabout 20% by weight of the total, a solvent component between about 60%and about 98% by weight of the total, and a plurality of polymers, whosecombined percentage is between about 0.1% and about 15% by weight of thetotal. In some variations the formulations further comprise stabilizingagents, excipients, adjuvants, or antioxidants, between about 0 andabout 40% by weight of the total.

In some variations, a liquid formulation may comprise about 4%therapeutic agent, including but not limited to rapamycin, per weight ofthe total; about 91% solvent by weight of the total; and about 5%polymeric component, per weight of the total.

The following references, each of which is incorporated herein byreference in its entirety, show one or more formulations, including butnot limited to rapamycin formulations, and which describe use ofrapamycin at various doses and other therapeutic agents for treatingvarious diseases or conditions: U.S. 60/651,790, titled FORMULATIONS FOROCULAR TREATMENT; U.S. 60/664,040, titled LIQUID FORMULATIONS FORTREATMENT OF DISEASES OR CONDITIONS; U.S. 60/664,119, titled DRUGDELIVERY SYSTEMS FOR TREATMENT OF DISEASES OR CONDITIONS; U.S.60/664,306, titled IN SITU GELLING FORMULATIONS AND LIQUID FORMULATIONSFOR TREATMENT OF DISEASES OR CONDITIONS; U.S. Ser. No. 11/351,844,titled FORMULATIONS FOR OCULAR TREATMENT; U.S. Ser. No. 11/351,761,titled LIQUID FORMULATIONS FOR TREATMENT OF DISEASES OR CONDITIONS; U.S.Ser. No. 11/386,290, titled DRUG DELIVERY SYSTEMS FOR TREATMENT OFDISEASES OR CONDITIONS; U.S. 60/772,018, titled STABLE FORMULATIONS, ANDMETHODS OF THEIR PREPARATION AND USE; US 2005/0187241; and US2005/0064010.

In some variations, the liquid formulation comprises a therapeutic agentor agents with a concentration of between about 0.01% and about 10% byweight of the total, and a solvent between about 10% and about 99% byweight of the total. In some variations the formulation furthercomprises a solubilizing agent including but not limited to asurfactant. In some variations the liquid formulation further comprisesa stabilizing agent, excipient, adjuvant, or antioxidant, etc., betweenabout 0 and about 40% by weight of the total. In some variations, thetherapeutic agent is about 5% by weight of the total, and the solventcomponent is about 95% by weight of the total.

In some variations the rapamycin in the liquid formulation containsbetween about 0.01 to about 10% of the total weight of the composition;between about 0.05 to about 10%; between about 0.1 to about 5%; betweenabout 1 to about 5%; or between about 5 to about 15%; between about 8 toabout 10%; between about 0.01 to about 1%; between about 0.05 to about5%; between about 0.1 to about 0.2%; between about 0.2 to about 0.3%;between about 0.3 to about 0.4%; between about 0.4 to about 0.5%;between about 0.5 to about 0.6%; between about 0.6 to about 0.7%;between about 0.7 to about 1%; between about 1 to about 3%; or betweenabout 1.5 to about 2.5%. In some variations the liquid formulationsdescribed herein contain between about 0.1 to about 5% w/w of rapamycin.

In some variations the non-aqueous liquid component is, by way ofnonlimiting example, between about 0.01 to about 99.9% of the totalweight of the composition; between about 0.1 to about 99%; between about75 to about 99.99%; between about 85 to about 99.99%; or between about55 to about 95% w/w. In some variations the non-aqueous liquid componentis between about 85 to about 99.99% w/w.

In some variations there is optionally a water component. In somevariations the water component is less than about 30%, less than about25%, less than about 20%, less than about 15%, less than about 10%, lessthan about 7.5%, less than about 5%, less than about 4%, less than about3%, less than about 2%, less than about 1%, or less than about 0.5%. Insome variations the water component is less than about 5% w/w.

Some variations of liquid formulations includes rapamycin between about0.01 and about 5% by weight of the total, and a non-aqueous liquidcomponent between about 95% and about 99.99% by weight of the total. Insome variations the formulations further comprise stabilizing agents,excipients, adjuvants, or antioxidants, between about 0 and about 5% byweight of the total.

In some variations, a liquid formulation contains about 2% w/w rapamycinand about 98% w/w of a non-aqueous liquid component. In some variations,the non-aqueous liquid component comprises ethanol. In some variations,the non-aqueous liquid component comprises a liquid polyethylene glycol,including but not limited to PEG 400.

In some variations the formulation contains 2% w/w rapamycin, 4% w/wethanol, and 94% w/w PEG 400.

In some variations, the formulation is diluted in a medium prior toadministration to a subject in need thereof.

The liquid formulations may be formulated for various routes ofadministration, including but not limited to delivery by any route ofadministration described herein, including but not limited to oraladministration of delivery by injection.

In Situ Gelling Formulations

In some variations, the formulations described herein are in situgelling formulations.

An “in situ gelling formulation,” as used herein, refers to a liquidformulation which forms a gel-like non-dispersed mass when the liquidformulation is placed in an aqueous medium, including but not limited toaqueous media that are water, the vitreous of an eye of a subject, andbetween the sclera and the conjunctiva of an eye of a subject. In somevariations, an in situ gelling formulation forms a gel-likenon-dispersed mass when placed in tap water.

In some variations, the in situ gelling formulation is a suspensionprior to placement in an aqueous medium, and forms a gel in situ uponplacement in an aqueous medium. In some variations, the in situ gellingformulation is a solution prior to placement in an aqueous medium, andforms a gel in situ upon placement in an aqueous medium. In somevariations, the in situ gelling formulation is an emulsion prior toplacement in an aqueous medium, and forms a gel in situ upon placementin an aqueous medium. In some variations a gel-like non-dispersed massforms after placement of the in situ gelling formulation into an aqueousmedium, including but not limited to any or all of water, an aqueousmedium of a subject, the vitreous of an eye, or between the sclera andthe conjunctiva of an eye. In some variations, the in situ gel is formedof a polymer matrix. In some variations a therapeutic agent is dispersedin the polymer matrix.

Described herein are in situ gelling formulations which may be used fortreating, preventing, inhibiting, delaying the onset of, or causing theregression of the diseases and conditions of a subject including but notlimited to a human subject. When used for treating, preventing,inhibiting, delaying the onset of, or causing the regression of thedisease or condition of the subject, the in situ gelling formulation isadministered to the subject.

In some variations, the in situ gelling formulation comprises one ormore polymers. Described herein are various types of polymers, includingpolymers which are solvents, polymers which are solubilizing agents,polymers which are release modifying agents, polymers which arestabilizing agents, etc. In some variations, any combination of polymersis used wherein the polymers when combined with the therapeutic agentform any or all of a non-dispersed mass, a gel, a hydrogel, or polymericmatrix when placed in an aqueous medium, including but not limited toany or all of water, the vitreous, or between the sclera and theconjunctiva.

In some variations, the in situ gelling formulation delivers extendedrelease of therapeutic agents to a subject when administered to thesubject.

In some variations, the in situ gelling formulation comprisesnanoparticles. In some variations, the nanoparticles are made bymilling.

In some variations, the formulation comprises a therapeutic agent and aplurality of polymers, wherein one of the polymers is apolymethacrylate. Polymethacrylates are known by various names and areavailable in various preparations, including but not limited topolymeric methacrylates, methacrylic acid-ethyl acrylate copolymer(1:1), methacrylic acid-ethyl acrylate copolymer (1:1) dispersion 30percent, methacrylic acid-methyl methacrylate copolymer (1:1),methacrylic acid-methyl methacrylate copolymer (1:2), acidummethacrylicum et ethylis acrylas polymerisatum 1:1, acidum methacrylicumet ethylis acrylas polymerisatum 1:1 dispersio 30 per centum, acidummethacrylicum et methylis methacrylas polymerisatum 1:1, acidummethacrylicum et methylis methacrylas polymerisatum 1:2, USPNF: ammoniomethacrylate copolymer, methacrylic acid copolymer, methacrylic acidcopolymer dispersion.

In some variations, one of the polymers is polyvinylpyrrolidone.Polyvinylpyrrolidone is known by various names and is available invarious preparations, including but not limited to povidone, povidonum,kollidon; plasdone; poly[1-(2-oxo-1-pyrrolidinyl)ethylene]; polyvidone;PVP; 1-vinyl-2-pyrrolidinone polymer, and 1-Ethenyl-2-pyrrolidinonehomopolymer.

One liquid formulation described herein comprises a therapeutic agentand a solvent component. The solvent component may comprise a singlesolvent or a combination of solvents.

In some variations, the solvent is glycerin, dimethylsulfoxide,N-methylpyrrolidone, ethanol, isopropyl alcohol, polyethylene glycol ofvarious molecular weights, including but not limited to PEG 300 and PEG400, or propylene glycol, or a mixture of one or more thereof.

In some variations, the solvent is polyethylene glycol. Polyethyleneglycol is known by various names and is available in variouspreparations, including but not limited to macrogels, macrogel 400,macrogel 1500, macrogel 4000, macrogel 6000, macrogel 20000, macrogola,breox PEG; carbowax; carbowax sentry; Hodag PEG; Lipo; Lipoxol; LutrolE; PEG; Pluriol E; polyoxyethylene glycol, andα-Hydro-ω-hydroxy-poly(oxy-1,2-ethanediyl).

Solubilization of Therapeutic Agents

One composition or liquid formulation that may be used is a compositionor liquid formulation in which the therapeutic agent is dissolved in asolvent component. Generally, any solvent which has the desired effectmay be used in which the therapeutic agent dissolves. In some variationsthe solvent is aqueous. In some variations the solvent is non-aqueous.An “aqueous solvent” is a solvent that contains at least about 50%water.

Generally, any concentration of solubilized therapeutic agent that hasthe desired effect can be used. The solvent component may be a singlesolvent or may be a mixture of solvents. The solvent component may be asingle solvent or may be a mixture of solvents. Solvents and types ofsolutions are well known to those versed in such drug deliverytechnologies. See for example, Remington: The Science and Practice ofPharmacy, Twentieth Edition, Lippincott Williams and Wilkins; 20thedition (Dec. 15, 2000); Ansel's Pharmaceutical Dosage Forms and DrugDelivery Systems, Eighth Edition, Lippincott Williams and Wilkins(August 2004); Handbook Of Pharmaceutical Excipients 2003, AmericanPharmaceutical Association, Washington, D.C., USA and PharmaceuticalPress, London, UK; and Strickley, solubilizing Excipients in Oral andInjectable Formulations, Pharmaceutical Research, Vol. 21, No. 2,February 2004.

As noted previously, some solvents may also serve as solubilizingagents.

Solvents that may be used include but are not limited to DMSO, ethanol,methanol, isopropyl alcohol; castor oil, propylene glycol, glycerin,polysorbate 80, benzyl alcohol, dimethyl acetamide (DMA), dimethylformamide (DMF), triacetin, diacetin, corn oil, acetyl triethyl citrate(ATC), ethyl lactate, glycerol formal, ethoxy diglycol (Transcutol,Gattefosse), tryethylene glycol dimethyl ether (Triglyme), dimethylisosorbide (DMI), γ-butyrolactone, N-Methyl-2-pyrrolidinone (NMP),polyethylene glycol of various molecular weights, including but notlimited to PEG 300 and PEG 400, and polyglycolated capryl glyceride(Labrasol, Gattefosse), combinations of any one or more of theforegoing, or analogs or derivatives of any one or more of theforegoing.

In some variations, the solvent is a polyethylene glycol. Polyethyleneglycol is known by various names and is available in variouspreparations, including but not limited to macrogels, macrogel 400,macrogel 1500, macrogel 4000, macrogel 6000, macrogel 20000, macrogola,breox PEG; carbowax; carbowax sentry; Hodag PEG; Lipo; Lipoxol; LutrolE; PEG; Pluriol E; polyoxyethylene glycol, andα-Hydro-ω-hydroxy-poly(oxy-1,2-ethanediyl).

In some variations the polyethylene glycol is a liquid PEG, and is oneor more of PEG 300 or PEG 400.

Other solvents include an amount of a C₆-C₂₄ fatty acid sufficient tosolubilize a therapeutic agent.

Phospholipid solvents may also be used, such as lecithin,phosphatidylcholine, or a mixture of various diglycerides of stearic,palmitic, and oleic acids, linked to the choline ester of phosphoricacid; hydrogenated soy phosphatidylcholine (HSPC),distearoylphosphatidylglycerol (DSPG),L-α-dimyristoylphosphatidylcholine (DMPC),L-α-dimyristoylphosphatidylglycerol (DMPG).

Further examples of solvents include, for example, components such asalcohols, propylene glycol, polyethylene glycol of various molecularweights, propylene glycol esters, propylene glycol esterified with fattyacids such as oleic, stearic, palmic, capric, linoleic, etc; mediumchain mono-, di-, or triglycerides, long chain fatty acids, naturallyoccurring oils, and a mixture thereof. The oily components for thesolvent system include commercially available oils as well as naturallyoccurring oils. The oils may further be vegetable oils or mineral oils.The oils can be characterized as non-surface active oils, whichtypically have no hydrophile lipophile balance value. Commerciallyavailable substances comprising medium chain triglycerides include, butare not limited to, Captex 100, Captex 300, Captex 355, Miglyol 810,Miglyol 812, Miglyol 818, Miglyol 829, and Dynacerin 660. Propyleneglycol ester compositions that are commercially available encompassCaptex 200 and Miglyol 840, and the like. The commercial product, CapmulMCM, comprises one of many possible medium chain mixtures comprisingmonoglycerides and diglycerides.

Other solvents include naturally occurring oils such as peppermint oil,and seed oils. Exemplary natural oils include oleic acid, castor oil,safflower seed oil, soybean oil, olive oil, sunflower seed oil, sesameoil, and peanut oil. Soy fatty acids may also be used. Examples of fullysaturated non-aqueous solvents include, but are not limited to, estersof medium to long chain fatty acids (such as fatty acid triglycerideswith a chain length of about C₆ to about C₂₄). Hydrogenated soybean oiland other vegetable oils may also be used. Mixtures of fatty acids maybe split from the natural oil (for example coconut oil, palm kernel oil,babassu oil, or the like) and refined. In some embodiments, medium chain(about C₈ to about C₁₂) triglycerides, such as caprilyic/caprictriglycerides derived from coconut oil or palm seed oil, may be used.Medium chain mono- and diglycerides may also be used. Other fullysaturated non-aqueous solvents include, but are not limited to,saturated coconut oil (which typically includes a mixture of lauric,myristic, palmitic, capric and caproic acids), including those soldunder the Miglyol™ trademark from Huls and bearing trade designations810, 812, 829 and 840). Also noted are the NeoBee™ products sold by DrewChemicals. Non-aqueous solvents include isopropyl myristate. Examples ofsynthetic oils include triglycerides and propylene glycol diesters ofsaturated or unsaturated fatty acids having 6 to 24 carbon atoms suchas, for example hexanoic acid, octanoic (caprylic), nonanoic(pelargonic), decanoic (capric), undecanoic, lauric, tridecanoic,tetradecanoic (myristic), pentadecanoic, hexadecanoic (palmitic),heptadecanoic, octadecanoic (stearic), nonadecanoic, heptadecanoic,eicosanoic, heneicosanoic, docosanoic and lignoceric acids, and thelike. Examples of unsaturated carboxylic acids include oleic, linoleicand linolenic acids, and the like. The non-aqueous solvent can comprisethe mono-, di- and triglyceryl esters of fatty acids or mixed glyceridesand/or propylene glycol mono- or diesters wherein at least one moleculeof glycerol has been esterified with fatty acids of varying carbon atomlength. A non-limiting example of a “non-oil” useful as a solvent ispolyethylene glycol.

Exemplary vegetable oils include cottonseed oil, corn oil, sesame oil,soybean oil, olive oil, fractionated coconut oil, peanut oil, sunfloweroil, safflower oil, almond oil, avocado oil, palm oil, palm kernel oil,babassu oil, beechnut oil, linseed oil, rape oil and the like. Mono-,di-, and triglycerides of vegetable oils, including but not limited tocorn, may also be used.

Polyvinyl pyrrolidone (PVP), cross-linked or not, may also be used as asolvent. Further solvents include but are not limited to C₆-C₂₄ fattyacids, oleic acid, Imwitor 742, Capmul, F68, F68 (Lutrol), PLURONICSincluding but not limited to PLURONICS F108, F127, and F68, Poloxamers,Jeffamines), Tetronics, F127; cyclodextrins such as α-cyclodextrin,β-cyclodextrin, hydroxypropyl-β-cyclodextrin,sulfobutylether-β-cyclodextrin (Captisol); CMC, polysorbitan 20,Cavitron, polyethylene glycol of various molecular weights including butnot limited to PEG 300 and PEG 400.

Beeswax and d-α-tocopherol (Vitamin E) may also be used as solvents.

Solvents for use in the liquid formulations can be determined by avariety of methods known in the art, including but not limited to (1)theoretically estimating their solubility parameter values and choosingthe ones that match with the therapeutic agent, using standard equationsin the field; and (2) experimentally determining the saturationsolubility of therapeutic agent in the solvents, and choosing the onesthat exhibit the desired solubility.

Solubilization of Rapamycin

Where the therapeutic agent is rapamycin, solvents that may be used formaking solutions or suspensions of rapamycin include but are not limitedto any solvent described herein, including but not limited to any one ormore of DMSO, glycerin, ethanol, methanol, isopropyl alcohol; castoroil, propylene glycol, polyvinylpropylene, glycerin, polysorbate 80,benzyl alcohol, dimethyl acetamide (DMA), dimethyl formamide (DMF),glycerol formal, ethoxy diglycol (Transcutol, Gattefosse), tryethyleneglycol dimethyl ether (Triglyme), dimethyl isosorbide (DMI),γ-butyrolactone, N-Methyl-2-pyrrolidinone (NMP), polyethylene glycol ofvarious molecular weights, including but not limited to PEG 300 and PEG400, and polyglycolated capryl glyceride (Labrasol, Gattefosse).

Further solvents include but are not limited to C₆-C₂₄ fatty acids,oleic acid, Imwitor 742, Capmul, F68, F68 (Lutrol), PLURONICS includingbut not limited to PLURONICS F108, F127, and F68, Poloxamers,Jeffamines), Tetronics, F127, beta-cyclodextrin, CMC, polysorbitan 20,Cavitron, softigen 767, captisol, and sesame oil.

Other methods that may be used to dissolve rapamycin are described inSolubilization of Rapamycin, P. Simamora et al. Int'l J. Pharma 213(2001) 25-29, the contents of which is incorporated herein in itsentirety.

As a nonlimiting example, rapamycin can be dissolved in 5% DMSO ormethanol in a balanced salt solution. The rapamycin solution can beunsaturated, a saturated or a supersaturated solution of rapamycin. Therapamycin solution can be in contact with solid rapamycin. In onenonlimiting example, rapamycin can be dissolved in a concentration of upto about 400 mg/ml. Rapamycin can also, for example, be dissolved inpropylene glycol esterified with fatty acids such as oleic, stearic,palmic, capric, linoleic, etc.

Many other solvents are possible. Those of ordinary skill in the artwill find it routine to identify solvents for rapamycin given theteachings herein.

Solubilizing Agents

Generally, any solubilizing agent or combination of solubilizing agentsmay be used in the liquid formulations described herein.

In some variations, the solubilizing agent is a surfactant orcombination of surfactants. Many surfactants are possible. Combinationsof surfactants, including combinations of various types of surfactants,may also be used. For instance, surfactants which are nonionic, anionic(i.e. soaps, sulfonates), cationic (i.e. CTAB), zwitterionic, polymericor amphoteric may be used.

Surfactants that can be used may be determined by mixing a therapeuticagent of interest with a putative solvent and a putative surfactant, andobserving the characteristics of the formulation after exposure to amedium.

Examples of surfactants include but are not limited to fatty acid estersor amides or ether analogues, or hydrophilic derivatives thereof;monoesters or diesters, or hydrophilic derivatives thereof; or mixturesthereof; monoglycerides or diglycerides, or hydrophilic derivativesthereof; or mixtures thereof; mixtures having enriched mono- or/anddiglycerides, or hydrophilic derivatives thereof; surfactants with apartially derivatized with a hydrophilic moiety; monoesters or diestersor multiple-esters of other alcohols, polyols, saccharides oroligosaccharides or polysaccharides, oxyalkylene oligomers or polymersor block polymers, or hydrophilic derivatives thereof, or the amideanalogues thereof; fatty acid derivatives of amines, polyamines,polyimines, aminoalcohols, aminosugars, hydroxyalkylamines,hydroxypolyimines, peptides, polypeptides, or the ether analoguesthereof.

Hydrophilic Lipophilic Balance (“HLB”) is an expression of the relativesimultaneous attraction of a surfactant for water and oil (or for thetwo phases of the emulsion system being considered).

Surfactants are characterized according to the balance between thehydrophilic and lipophilic portions of their molecules. Thehydrophilic-lipophilic balance (HLB) number indicates the polarity ofthe molecule in an arbitrary range of 1-40, with the most commonly usedemulsifiers having a value between 1-20. The HLB increases withincreasing hydrophilicity.

Surfactants that may be used include but are not limited to those withan HLB greater than 10, 11, 12, 13 or 14. Examples of surfactantsinclude polyoxyethylene products of hydrogenated vegetable oils,polyethoxylated castor oils or polyethoxylated hydrogenated castor oil,polyoxyethylene-sorbitan-fatty acid esters, polyoxyethylene castor oilderivatives and the like, for example, Nikkol HCO-50, Nikkol HCO-35,Nikkol HCO-40, Nikkol HCO-60 (from Nikko Chemicals Co. Ltd.); Cremophor(from BASF) such as Cremophor RH40, Cremophor RH60, Cremophor EL, TWEENs(from ICI Chemicals) e.g., TWEEN 20, TWEEN 21, TWEEN 40, TWEEN 60, TWEEN80, TWEEN 81, Cremophor RH 410, Cremophor RH 455 and the like.

The surfactant component may be selected from compounds having at leastone ether formed from at least about 1 to 100 ethylene oxide units andat least one fatty alcohol chain having from at least about 12 to 22carbon atoms; compounds having at least one ester formed from at leastabout 1 to 100 ethylene oxide units and at least one fatty acid chainhaving from at least about 12 to 22 carbon atoms; compounds having atleast one ether, ester or amide formed from at least about 1 to 100ethylene oxide units and at least one vitamin or vitamin derivative; andcombinations thereof consisting of no more than two surfactants.

Other examples of surfactants include Lumulse GRH-40, TGPS,Polysorbate-80 (TWEEN-80), Polysorbate-20 (TWEEN-20), polyoxyethylene(20) sorbitan mono-oleate), glyceryl glycol esters, polyethylene glycolesters, polyglycolyzed glycerides, and the like, or mixtures thereof;polyethylene sorbitan fatty acid esters, polyoxyethylene glycerolesters, such as Tagat TO, Tagat L, Tagat I, tagat I2 and Tagat 0(commercially available from Goldschmidt Chemical Co., Essen, Germany);ethylene glycol esters, such as glycol stearate and distearate;propylene glycol esters, such as propylene glycol myristate; glycerylesters of fatty acids, such as glyceryl stearates and monostearates;sorbitan esters, such as spans and TWEENs; polyglyceryl esters, such aspolyglyceryl 4-oleate; fatty alcohol ethoxylates, such as Brij typeemulsifiers; ethoxylated propoxylated block copolymers, such aspoloxamers; polyethylene glycol esters of fatty acids, such as PEG 300linoleic glycerides or Labrafil 2125 CS, PEG 300 oleic glycerides orLabrafil M 1944 CS, PEG 400 caprylic/capric glycerides or Labrasol, andPEG 300 caprylic/capric glycerides or Softigen 767; cremophors, such asCremophor E, polyoxyl 35 castor oil or Cremophor EL, Cremophor EL-P,Cremophor RH 4OP, polyoxyl 40 hydrogenated castor oil, Cremophor RH40;polyoxyl 60 hydrogenated castor oil or Cremophor RH 60, glycerolmonocaprylate/caprate, such as Campmul CM 10; polyoxyethylated fattyacids (PEG-stearates, PED-laurates, Brij®), polyoxylated glycerides offatty acid, polyoxylated glycerol fatty acid esters i.e. Solutol HS-15;PEG-ethers (Mirj®), sorbitan derivatives (TWEENs), sorbitan monooleateor Span 20, aromatic compounds (Tritons®), PEG-glycerides (PECEOL™),PEG-PPG (polypropylene glycol) copolymers (PLURONICS including but notlimited to PLURONICS F108, F127, and F68, Poloxamers, Jeffamines),Tetronics, Polyglycerines, PEG-tocopherols, PEG-LICOL 6-oleate;propylene glycol derivatives, sugar and polysaccharide alkyl and acylderivatives (octylsucrose, sucrose stearate, laurolydextran etc.) and/ora mixture thereof; surfactants based on an oleate or laureate ester of apolyalcohol copolymerized with ethylene oxide; Labrasol Gelucire 44/14;polyoxytheylene stearates; saturated polyglycolyzed glycerides; orpoloxamers; all of which are commercially available. Polyoxyethylenesorbitan fatty acid esters can include polysorbates, for example,polysorbate 20, polysorbate 40, polysorbate 60, and polysorbate 80.Polyoxyethylene stearates can include polyoxyl 6 stearate, polyoxyl 8stearate, polyoxyl 12 stearate and polyoxyl 20 stearate. Saturatedpolyglycolyzed glycerides are, for example, GELUCIRE 44/14 or GELUCIRE™50/13 (Gattefosse, Westwood, N.J., U.S.A.). Poloxamers used hereininclude poloxamer 124 and poloxamer 188.

Surfactants include d-α-tocopheryl polyethylene glycol 1000 succinate(TPGS), polyoxyl 8 stearate (PEG 400 monostearate), polyoxyl 40 stearate(PEG 1750 monostearate) and peppermint oil.

In some variations, surfactants having an HLB lower than 10 are used.Such surfactants may optionally be used in combination with othersurfactants as co-surfactants. Examples of some surfactants, mixtures,and other equivalent compositions having an HLB less than or equal to 10are propylene glycols, glyceryl fatty acids, glyceryl fatty acid esters,polyethylene glycol esters, glyceryl glycol esters, polyglycolyzedglycerides and polyoxyethyl steryl ethers. Propylene glycol esters orpartial esters form the composition of commercial products, such asLauroglycol FCC, which contains propylene glycol laureate. Thecommercially available excipient Maisine 35-1 comprises long chain fattyacids, for example glyceryl linoleate. Products, such as Acconon E,which comprise polyoxyethylene stearyl ethers, may also be used.Labrafil M 1944 CS is one example of a surfactant wherein thecomposition contains a mixture of glyceryl glycol esters andpolyethylene glycol esters.

Solubilizing Agents for Rapamycin

Many solubilizing agents may be used for rapamycin, including but notlimited to those in the solubilizing agents section above.

In some variations the solubilizing agent is a surfactant. Nonlimitingexamples of surfactants that may be used for rapamycin include but arenot limited to surfactants with an HLB greater than 10, 11, 12, 13 or14. One nonlimiting example is Cremophor EL. In some variations, thesurfactant may be a polymeric surfactant including but not limited toPLURONICS F108, F127, and F68, and Tetronics. As noted herein, somesolvents may also serve as surfactants. Those of ordinary skill in theart will find it routine to identify which solubilizing agents andsurfactants may be used for rapamycin given the teachings herein.

Viscosity Modifying Agents

The liquid formulations described herein may be administered with orfurther comprise a viscosity modifying agent.

One exemplary viscosity modifying agent that may be used is hyaluronicacid. Hyaluronic acid is a glycosaminoglycan. It is made of a repetitivesequence of glucuronic acid and glucosamine. Hyaluronic acid is presentin many tissues and organs of the body, and contributes to the viscosityand consistency of such tissues and organs. Hyaluronic acid is presentin the eye, including the vitreous of the eye, and along with collagencontributes to the viscosity thereof. The liquid formulations describedherein may further comprise or be administered with hyaluronic acid.

Other nonlimiting examples of viscosity modifying agents includepolyalkylene oxides, glycerol, carboxymethyl cellulose, sodium alginate,chitosan, dextran, dextran sulfate and collagen. These viscositymodifying agents can be chemically modified.

Other viscosity modifying agents that may be used include but are notlimited to carrageenan, cellulose gel, colloidal silicon dioxide,gelatin, propylene carbonate, carbonic acid, alginic acid, agar,carboxyvinyl polymers or carbomers and polyacrylamides, acacia, estergum, guar gum, gum arabic, ghatti, gum karaya, tragacanth, terra,pectin, tamarind seed, larch arabinogalactan, alginates, locust bean,xanthan gum, starch, veegum, tragacanth, polyvinyl alcohol, gellan gum,hydrocolloid blends, and povidone. Other viscosity modifying agentsknown in the art can also be used, including but not limited to sodiumcarboxymethyl cellulose, algin, carageenans, galactomannans, hydropropylmethyl cellulose, hydroxypropyl cellulose, polyethylene glycol,polyvinylpyrrolidone, sodium carboxymethyl chitin, sodium carboxymethyldextran, sodium carboxymethyl starch, xanthan gum, and zein.

Other Components of Formulations

The formulations described herein may further comprise various othercomponents such as stabilizers, for example. Stabilizers that may beused in the formulations described herein include but are not limited toagents that will (1) improve the compatibility of excipients with theencapsulating materials such as gelatin, (2) improve the stability (e.g.prevent crystal growth of a therapeutic agent such as rapamycin) of atherapeutic agent such as rapamycin and/or rapamycin derivatives, and/or(3) improve formulation stability. Note that there is overlap betweencomponents that are stabilizers and those that are solvents,solubilizing agents or surfactants, and the same component can carry outmore than one role.

Stabilizers may be selected from fatty acids, fatty alcohols, alcohols,long chain fatty acid esters, long chain ethers, hydrophilic derivativesof fatty acids, polyvinylpyrrolidones, polyvinylethers, polyvinylalcohols, hydrocarbons, hydrophobic polymers, moisture-absorbingpolymers, and combinations thereof. Amide analogues of the abovestabilizers can also be used. The chosen stabilizer may change thehydrophobicity of the formulation (e.g. oleic acid, waxes), or improvethe mixing of various components in the formulation (e.g. ethanol),control the moisture level in the formula (e.g. PVP), control themobility of the phase (substances with melting points higher than roomtemperature such as long chain fatty acids, alcohols, esters, ethers,amides etc. or mixtures thereof; waxes), and/or improve thecompatibility of the formula with encapsulating materials (e.g. oleicacid or wax). Some of these stabilizers may be used assolvents/co-solvents (e.g. ethanol). Stabilizers may be present insufficient amount to inhibit the therapeutic agent's (such asrapamycin's) crystallization.

Examples of stabilizers include, but are not limited to, saturated,monoenoic, polyenoic, branched, ring-containing, acetylenic,dicarboxylic and functional-group-containing fatty acids such as oleicacid, caprylic acid, capric acid, caproic acid, lauric acid, myristicacid, palmitic acid, stearic acid, behenic acid, linoleic acid,linolenic acid, eicosapentaenoic acid (EPA), DHA; fatty alcohols such asstearyl alcohol, cetyl alcohol, ceteryl alcohol; other alcohols such asethanol, isopropyl alcohol, butanol; long chain fatty acid esters,ethers or amides such as glyceryl stearate, cetyl stearate, oleylethers, stearyl ethers, cetyl ethers, oleyl amides, stearyl amides;hydrophilic derivatives of fatty acids such as polyglyceryl fatty acids,polyethylene glycol fatty acid esters; polyvinylpyrrolidones,polyvinylalcohols (PVAs), waxes, docosahexaenoic acid andde-hydroabietic acid etc.

The formulations described may further contain a gelling agent thatalters the texture of the final formulation through formation of a gel.

The therapeutic agents for use as described herein, such as rapamycin,may be subjected to conventional pharmaceutical operations, such assterilization and compositions containing the therapeutic agent may alsocontain conventional adjuvants, such as preservatives, stabilizers,wetting agents, emulsifiers, buffers etc. The therapeutic agents mayalso be formulated with pharmaceutically acceptable excipients forclinical use to produce a pharmaceutical composition. Formulations maybe presented as a solution, suspension, particles of solid material, adiscrete mass of solid material, nanoparticles, incorporated within apolymer matrix, liquid formulations or in any other form appropriate forthe selected route of administration. The therapeutic agents may be usedto prepare a medicament to treat, prevent, inhibit, delay onset, orcause regression of any of the conditions described herein. In somevariations, the therapeutic agents may be used to prepare a medicamentto treat any of the conditions described herein.

A composition containing a therapeutic agent such as rapamycin maycontain one or more adjuvants appropriate for the indicated route ofadministration. Adjuvants with which the therapeutic agent may beadmixed with include but are not limited to lactose, sucrose, starchpowder, cellulose esters of alkanoic acids, stearic acid, talc,magnesium stearate, magnesium oxide, sodium and calcium salts ofphosphoric and sulphuric acids, acacia, gelatin, sodium alginate,polyvinylpyrrolidine, and/or polyvinyl alcohol. When a solubilizedformulation is required the therapeutic agent may be in a solventincluding but not limited to polyethylene glycol of various molecularweights, propylene glycol, carboxymethyl cellulose colloidal solutions,methanol, ethanol, DMSO, corn oil, peanut oil, cottonseed oil, sesameoil, tragacanth gum, and/or various buffers. Other adjuvants and modesof administration are well known in the pharmaceutical art and may beused in the practice of the methods, compositions and liquidformulations described herein. The carrier or diluent may include timedelay material, such as glyceryl monostearate or glyceryl distearatealone or with a wax, or other materials well known in the art. Theformulations for use as described herein may also include gelformulations, erodible and non-erodible polymers, microspheres, andliposomes.

Other adjuvants and excipients that may be used include but are notlimited to C₈-C₁₀ fatty acid esters such as softigen 767, polysorbate80, PLURONICS, Tetronics, Miglyol, and Transcutol.

Additives and diluents normally utilized in the pharmaceutical arts canoptionally be added to the pharmaceutical composition and the liquidformulation. These include thickening, granulating, dispersing,flavoring, sweetening, coloring, and stabilizing agents, including pHstabilizers, other excipients, anti-oxidants (e.g., tocopherol, BHA,BHT, TBHQ, tocopherol acetate, ascorbyl palmitate, ascorbic acid propylgallate, and the like), preservatives (e.g., parabens), and the like.Exemplary preservatives include, but are not limited to, benzylalcohol,ethylalcohol, benzalkonium chloride, phenol, chlorobutanol, and thelike. Some useful antioxidants provide oxygen or peroxide inhibitingagents for the formulation and include, but are not limited to,butylated hydroxytoluene, butylhydroxyanisole, propyl gallate, ascorbicacid palmitate, α-tocopherol, and the like. Thickening agents, such aslecithin, hydroxypropylcellulose, aluminum stearate, and the like, mayimprove the texture of the formulation.

In some variations, the therapeutic agent is rapamycin, and therapamycin is formulated as RAPAMUNE in solid or liquid form. In somevariations, the RAPAMUNE is formulated as an oral dosage.

In addition, a viscous polymer may be added to the suspension, assistingthe localization and ease of placement and handling. In some uses of theliquid formulation, a pocket in the sclera may be surgically formed toreceive an injection of the liquid formulations. The hydrogel structureof the sclera can act as a rate-controlling membrane. Particles oftherapeutic agent substance for forming a suspension can be produced byknown methods including but not limited to via ball milling, for exampleby using ceramic beads. For example, a Cole Parmer ball mill such asLabmill 8000 may be used with 0.8 mm YTZ ceramic beads available fromTosoh or Norstone Inc.

The formulations may conveniently be presented in unit dosage form andmay be prepared by conventional pharmaceutical techniques. Suchtechniques include the step of bringing into association the therapeuticagent and the pharmaceutical carrier(s) or excipient(s). Theformulations may be prepared by uniformly and intimately bringing intoassociate the active ingredient with liquid carriers or finely dividedsolid carriers or both, and then, if necessary, shaping the product.

In some variations, the formulations described herein are provided inone or more unit dose forms, wherein the unit dose form contains anamount of a liquid formulation described herein that is effective totreat or prevent the disease or condition for which it is beingadministered. In some variations, the formulations described herein areprovided in one or more unit dose forms, wherein the unit dose formcontains an amount of a liquid rapamycin formulation described hereinthat is effective to treat or prevent the disease or condition for whichit is being administered.

In some embodiments, the unit dose form is prepared in the concentrationat which it will be administered. In some variations, the unit dose formis diluted prior to administration to a subject. In some variations, aliquid formulation described herein is diluted in an aqueous mediumprior to administration to a subject. In some variations the aqueousmedium is an isotonic medium. In some variations, a liquid formulationdescribed herein is diluted in an non-aqueous medium prior toadministration to a subject.

In a further aspect, provided herein are kits comprising one or moreunit dose forms as described herein. In some embodiments, the kitcomprises one or more of packaging and instructions for use to treat oneor more diseases or conditions. In some embodiments, the kit comprises adiluent which is not in physical contact with the formulation orpharmaceutical formulation. In some embodiments, the kit comprises anyof one or more unit dose forms described herein in one or more sealedvessels. In some embodiments, the kit comprises any of one or moresterile unit dose forms.

In some variations, the unit dose form is in a container, including butnot limited to a sterile sealed container. In some variations thecontainer is a vial, ampule, or low volume applicator, including but notlimited to a syringe. In some variations, a low-volume applicator ispre-filled with rapamycin for treatment of an ophthalmic disease orcondition, including but not limited to a limus compound for treatmentof age-related macular degeneration. Described herein is a pre-filledlow-volume applicator pre-filled with a formulation comprising atherapeutic agent, including but not limited to rapamycin. In somevariations a low-volume applicator is pre-filled with a solutioncomprising a therapeutic agent, including but not limited to rapamycinand a polyethylene glycol, and optionally further comprises one or moreadditional components including but not limited to ethanol. In somevariations a pre-filled low-volume applicator is pre-filled with asolution comprising about 2% rapamycin, about 94% PEG-400, about 4%ethanol.

Described herein are kits comprising one or more containers. In somevariations a kit comprises one or more low-volume applicators ispre-filled with a formulation described herein comprising a therapeuticagent, including but not limited to formulations comprising rapamycin,formulations comprising rapamycin and a polyethylene glycol, andoptionally further comprises one or more additional components includingbut not limited to ethanol, and formulations in liquid form comprisingabout 2% rapamycin, about 94% PEG-400, about 4% ethanol. In somevariations the kit comprises one or more containers, including but notlimited to pre-filled low-volume applicators, with instructions for itsuse. In a further variation a kit comprises one or more low-volumeapplicators pre-filled with rapamycin, with instructions for its use intreating a disease or condition described herein. In some variations,the containers described herein are in a secondary packaging.

Methods of Treatment

Unless the context clearly indicates otherwise, any of the therapeuticagents described herein may be used in a method described herein fortreating, preventing, inhibiting, delaying on set of, or causing theregression of any of the diseases and conditions described herein.

In some variations any one or more of the formulations described hereinare used to deliver one or more therapeutic agents described herein viaa method described herein. Generally, the therapeutic agent may beformulated in any formulation capable of delivery of a therapeuticallyeffective amount of the therapeutic agent to a subject or to the subjectfor the required treatment period. In some variations the requiredtreatment period is met by a single administration of a sustainedrelease formulation that is predicted to deliver an effective amount ofthe therapeutic agent for the predicted duration period of the diseaseor condition. In some variations the required treatment period is met bya schedule of multiple administrations.

In some variations the required treatment period is met by multipleadministrations of a formulation, including but not limited to asustained release formulation.

As used herein, to “inhibit” a disease or condition by administration ofa therapeutic agent means that the progress of at least one detectablephysical characteristic or symptom of the disease or condition is slowedor stopped following administration of the therapeutic agent as comparedto the progress of the disease or condition without administration ofthe therapeutic agent.

As used herein, to “prevent” a disease or condition by administration ofa therapeutic agent means that the detectable physical characteristicsor symptom of the disease or condition do not develop followingadministration of the therapeutic agent.

As used herein, to “delay onset of” a disease or condition byadministration of a therapeutic agent means that at least one detectablephysical characteristic or symptom of the disease or condition developslater in time following administration of the therapeutic agent ascompared to the progress of the disease or condition withoutadministration of the therapeutic agent.

As used herein, to “treat” a disease or condition by administration of atherapeutic agent means that the progress of at least one detectablephysical characteristic or symptom of the disease or condition isslowed, stopped, or reversed following administration of the therapeuticagent as compared to the progress of the disease or condition withoutadministration of the therapeutic agent.

As used herein, to “cause regression of” a disease or condition byadministration of a therapeutic agent means that the progress of atleast one detectable physical characteristic or symptom of the diseaseor condition is reversed to some extent following administration of thetherapeutic agent.

A subject, including but not limited to a human subject, having apredisposition for or in need of prevention may be identified by theskilled practitioner by established methods and criteria in the fieldgiven the teachings herein. The skilled practitioner may also readilydiagnose individuals as in need of inhibition or treatment based uponestablished criteria in the field for identifying angiogenesis and/orneovascularization given the teachings herein.

As used herein, a “subject” is generally any animal that may benefitfrom administration of the formulations described herein. In somevariations the therapeutic agents are administered to a mammaliansubject. In some variations the formulations are administered to a humansubject. In some variations the formulations are administered to aveterinary animal subject. In some variations the formulations areadministered to a model experimental animal subject. In some variationsthe formulations are administered to a veterinary animal that is a pet.In some variations the formulations are administered to a veterinaryanimal that is of agronomic relevance.

An “effective amount,” which is also referred to herein as a“therapeutically effective amount,” of a therapeutic agent foradministration as described herein is that amount of the therapeuticagent that provides the therapeutic effect sought when administered tothe subject, including but not limited to a human subject. The achievingof different therapeutic effects may require different effective amountsof therapeutic agent. For example, the therapeutically effective amountof a therapeutic agent used for preventing a disease or condition may bedifferent from the therapeutically effective amount used for treating,inhibiting, delaying the onset of, or causing the regression of thedisease or condition. In addition, the therapeutically effective amountmay depend on the age, weight, and other health conditions of thesubject as is well know to those versed in the disease or conditionbeing addressed. Thus, the therapeutically effective amount may not bethe same in every subject to which the therapeutic agent isadministered.

An effective amount of a therapeutic agent for treating, preventing,inhibiting, delaying the onset of, or causing the regression of aspecific disease or condition is also referred to herein as the amountof therapeutic agent effective to treat, prevent, inhibit, delay theonset of, or cause the regression of the disease or condition.

Those of skill in the art will know how to determine the appropriatelevel of a therapeutic agent described herein to treat a disease orcondition described herein, based on the teachings provided in thisspecification and in the drawings. As one example, to determine whethera level of a therapeutic agent is a “therapeutically effective amount”to treat, prevent, inhibit, delay on set of, or cause the regression ofthe diseases and conditions described in the Diseases and Conditionssection, a formulation may be administered in in vitro or in animalmodels for the diseases or conditions of interest, and the effects maybe observed. A nonlimiting example of scientific references related totissue accumulation and pharmokinetics of rapamycin is Napoli andTaylor, From Beach to Bedside: History of the Development of Sirolimus,23:559-586 (2001). In addition, dose ranging human clinical trials maybe conducted to determine the therapeutically effective amount of atherapeutic agent.

An “effective anti-permeability amount,” which is also referred toherein as a “therapeutically effective anti-permeability amount,” of atherapeutic agent as described herein is that amount of the therapeuticagent that provides an anti-permeability effect when administered to asubject, including but not limited to a human subject. The achieving ofanti-permeability effects may require different effective amounts oftherapeutic agent depending on the disease being treated, prevented,inhibited, onset delayed, or regression caused. The achieving ofanti-permeability effects may require different effective amounts oftherapeutic agent depending on the tissue being treated. In addition,the effective anti-permeability amount may depend on the age, weight,and other health conditions of the subject as is well know to thoseversed in the disease or condition being addressed. Thus, the effectiveanti-permeability amount may not be the same in every subject to whichthe therapeutic agent is administered. Those of skill in the art areversed in determining the effective amount for a given subject giventhese parameters and the teachings herein.

Doses and Tissue Levels

Unless the context clearly indicates otherwise, any of the formulationsdescribed herein may be used to administer the doses or deliver thetissue levels of any of the therapeutic agents described herein to asubject in need thereof. Unless the context clearly indicates otherwise,the subject may be a veterinary, a mammalian, or a human subject. Insome variations, the subject is a human subject.

In some variations, an amount or concentration of a therapeutic agent isadministered that is equivalent to an amount or concentration ofrapamycin. Those of skill in the art, based on the teachings herein candetermine what amount or concentration of a given therapeutic agent isequivalent to an amount or concentration of rapamycin by, for example,administering the therapeutic agent at various amounts or concentrationsto a disease model system, such as an in vivo or in vivo model system,and comparing the results in the model system relative to the results ofvarious amounts or concentrations of rapamycin. Those of skill in theart, based on the teachings herein can also determine what amount orconcentration of a given therapeutic agent is equivalent to an amount orconcentration of rapamycin by reviewing the scientific literature forexperiments performed comparing rapamycin to other therapeutic agents.It is understood that even the same therapeutic agent may have adifferent equivalent level of rapamycin when, for example, a differentdisease or disorder is being evaluated, or a different type offormulation is used. Nonlimiting examples of scientific references withcomparative studies of rapamycin and other therapeutic agents on oculardisease are Ohia et al., Effects of steroids and immunosuppressive drugson endotoxin-uveitis in rabbits, J. Ocul. Pharmacol. 8(4):295-307(1992); Kulkarni, Steroidal and nonsteroidal drugs in endotoxin-induceduveitis, J. Ocul. Pharmacol. 10(1):329-34 (1994); Hafizi et al.,Differential effects of rapamycin, cyclosporine A, and FK506 on humancoronary artery smooth muscle cell proliferation and signaling, VasculPharmacol. 41(4-5):167-76 (2004); and US 2005/0187241.

As one nonlimiting example, in a model for retinal edema, if atherapeutic agent is found to be approximately 10-fold less potent orefficacious than rapamycin in the treatment of retinal edema, a dose of10× of the therapeutic agent would be equivalent to a 1× dose ofrapamycin. Or if a therapeutic agent is found to be approximately10-fold more potent or efficacious than rapamycin in the treatment ofretinal edema, a 0.1× dose of the therapeutic agent would beadministered relative to a 1× dose of rapamycin. Other models for thediseases or conditions described herein may be used to determine theappropriate amount of a therapeutic agent that is equivalent to a givenamount of rapamycin for the therapeutic effect sought, such as treatingor preventing the disease or disorder.

Unless the context clearly indicates otherwise, any of the therapeuticagents described herein may be delivered in an amount equivalent to anamount of rapamycin. Unless the context clearly indicates otherwise, anyanalogs, derivatives, prodrugs, salts or esters of the therapeuticagents described herein may be delivered in an amount equivalent to anamount of rapamycin. Unless the context clearly indicates otherwise, anyanalogs, derivatives, prodrugs, salts or esters of rapamycin describedherein may be delivered in an amount equivalent to an amount ofrapamycin.

In some variations, the therapeutic agent is an immunophilin bindingcompound or an analog, derivative, prodrug, salt or ester thereof. Insome variations, the therapeutic agent is a limus compound or an analog,derivative, prodrug, salt or ester thereof. In some variations, thetherapeutic agent is rapamycin or an analog, derivative, prodrug, saltor ester thereof. In some variations, the therapeutic agent is SDZ-RAD,tacrolimus, everolimus, pimecrolimus, CCI-779, AP23841, ABT-578,TAFA-93, RAD-001, temsirolimus, AP23573, 7-epi-rapamycin,7-thiomethyl-rapamycin, 7-epi-trimethoxyphenyl-rapamycin,7-epi-thiomethyl-rapamycin, 7-demethoxy-rapamycin,32-demethoxy-rapamycin, 2-desmethyl-rapamycin, monoester derivatives ofrapamycin, diester derivatives of rapamycin, 27-oximes of rapamycin;42-oxo analogs of rapamycin; bicyclic rapamycins; rapamycin dimers;silyl ethers of rapamycin; rapamycin arylsulfonates, rapamycinsulfamates, monoesters at positions 31 and 42, diesters at positions 31and 42, 30-demethoxy rapamycin, and pharmaceutically acceptable saltsand esters thereof. In some variations, the therapeutic agent israpamycin, SDZ-RAD, tacrolimus, everolimus, pimecrolimus, CCI-779,AP23841, ABT-578, and pharmaceutically acceptable salts and estersthereof. In some variations the therapeutic agent is rapamycin.

In some nonlimiting variations, the diseases or conditions describedherein are treated, prevented, inhibited, regression caused, or onsetdelayed by administering an amount of therapeutic agent giving a tissuelevel concentration in the tissue associated with the disease orcondition which is equivalent to a rapamycin concentration of betweenabout 0.001 pg/mg and about 20 μg/mg. In some nonlimiting variations,the diseases or conditions described herein are treated, prevented,inhibited, regression caused, or onset delayed by providing an amount oftherapeutic agent giving a tissue level concentration in the tissueassociated with the disease or condition which is equivalent to arapamycin concentration of between 0.001 ng/ml and 10 mg/ml.

In some nonlimiting variations, the diseases or conditions describedherein are treated, prevented, inhibited, regression caused, or onsetdelayed by providing an amount of therapeutic agent giving a tissuelevel concentration in the tissue associated with the disease orcondition which is equivalent to a rapamycin concentration of between0.001 pg/mg and 20 μg/mg, between 0.001 pg/mg and 1 ng/mg, between 0.001pg/mg and 10 ng/mg, between 0.01 pg/mg and 100 ng/mg, between 0.01 pg/mgand 10 ng/mg, between 0.1 pg/mg and 100 ng/mg, between 1 ng/mg and 1μg/mg, between 1 ng/mg and 500 ng/mg, between 10 n/mg and 400 μg/mg,between between 1 ng/mg and 300 ng/mg, between 200 ng/mg and 700 ng/mg,between 500 ng/mg and 1 μg/mg, between 800 ng/mg and 1.2 μg/mg, orbetween 1 μg/mg and 5 μg/mg. In some variations, the therapeutic agentis rapamycin.

In some nonlimiting variations, the diseases or conditions describedherein are treated, prevented, inhibited, regression caused, or onsetdelayed by providing an amount of therapeutic agent giving a tissuelevel concentration in the tissue associated with the disease orcondition which is equivalent to a rapamycin concentration of betweenabout 0.001 ng/ml and about 10 mg/ml, between 0.01 ng/ml and 1 μg/ml,between 1 ng/ml and 1 μg/ml, between 0.01 ng/ml and 100 μg/ml, between0.01 ng/ml and 10 ng/ml, between 0.1 ng/ml and 100 μg/ml, between 100ng/ml and 1 μg/ml, between 1 μg/ml and 500 μg/ml, between 10 mg/ml and400 mg/ml, between between 1 μg/ml and 300 μg/ml, between 200 ng/mg and700 μg/ml, between 500 ng/mg and 5 mg/ml, between 500 μg/ml and 1 mg/ml,or between 1 mg/ml and 5 mg/ml. In some variations, the therapeuticagent is rapamycin.

Those of skill in the art will perceive that the dose and the route ofadministration depend upon the disease or disorder being treated,prevented, inhibited, regression caused, or onset delayed.

In some variations, an effective amount of rapamycin is delivered to asubject. In some variations, an effective antipermeability amount ofrapamycin is delivered to a subject. In some variations, an amount ofrapamycin is administered in a formulation which results in aconcentration of between 0.001 pg/mg and 20 μg/mg of rapamycin in atissue associated with the disease or disorder being treated, prevented,inhibited, regression caused, or onset delayed. In some variations, anamount of rapamycin is administered in a formulation which results in aconcentration of between 0.001 ng/ml and about 10 mg/ml in a tissueassociated with the disease or disorder being treated, prevented,inhibited, regression caused, or onset delayed.

Those of skill in the art, based on the teachings herein and byreviewing scientific literature can determine the human equivalentdosage of a given therapeutic agent based on the amount or concentrationof rapamycin given to an animal (i.e., a hamster). One such method ofcalculating human equivalent doses is provided in the FDA Guidance forIndustry and Reviewers, Estimating the Safe Start Dose of Clinical Trialfor Therapeutics in Adult Healthy Volunteers, available athttp://www.fda.gov/cber/gdlns/dose.htm. For example, to convert hamsterdoses in mg/kg to human equivalent doses in mg/kg, the hamster dosage inmg/kg may be divided by 7.4 to equal a human equivalent dosage in mg/kg.Those of skill in the art, in view of the teachings described herein andtheir knowledge about the relative dosings of certains animal subjectsand, for example, human subjects, will be able to determine theappropriate amount of the therapeutic agent.

In some nonlimiting variations, the diseases or conditions describedherein are treated, prevented, inhibited, regression caused, or onsetdelayed by administering a dose of a therapeutic agent to a subjectwhich is equivalent to a dose of rapamycin of no greater than about 2mg/kg, or no greater than about 0.5 mg/kg, or no greater than about 0.1mg/kg. In some variations, the diseases or conditions described hereinare treated, prevented, inhibited, regression caused, or onset delayedby administering a dose of a therapeutic agent to a subject which isequivalent to a dose of rapamycin of any of about between 0.1 mg/kg to0.5 mg/kg or between 0.1 mg/kg to 2.0 mg/kg. In some variations, thediseases or conditions described herein are treated, prevented,inhibited, regression caused, or onset delayed by administering a doseof a therapeutic agent to a subject which is equivalent to a dose ofrapamycin of any of about 0.1 mg/kg, 0.5 mg/kg, or 2.0 mg/kg.

In some nonlimiting variations, the diseases or conditions describedherein are treated, prevented, inhibited, regression caused, or onsetdelayed by administering a dose of a therapeutic agent to a subjectwhich is equivalent to a dose of rapamycin of no greater than about 0.27mg/kg, or no greater than about 0.067 mg/kg, or no greater than about0.0135 mg/kg. In some variations, the diseases or conditions describedherein are treated, prevented, inhibited, regression caused, or onsetdelayed by administering a dose of a therapeutic agent to a subjectwhich is equivalent to a dose of rapamycin of either of between 0.0135mg/kg to 0.067 mg/kg or between 0.0135 mg/kg to 0.27 mg/kg. In somevariations, the diseases or conditions described herein are treated,prevented, inhibited, regression caused, or onset delayed byadministering a dose of a therapeutic agent to a subject which isequivalent to a dose of rapamycin of any of about 0.0135 mg/kg, 0.067mg/kg, or 0.27 mg/kg.

In some nonlimiting variations, the diseases or conditions describedherein are treated, prevented, inhibited, regression caused, or onsetdelayed by administering to a subject in need thereof an effectiveamount or effective antipermeability amount of a formulation that wheninjected intraperitoneally into a hamster delivers an amount of thetherapeutic agent sufficient to achieve an average concentration oftherapeutic agent in cheek tissue of the hamster equivalent to arapamycin concentration of any of no greater than about 7 ng/g, nogreater than about 11 ng/g, or no greater than about 40 ng/g. In somevariations, the diseases or conditions described herein are treated,prevented, inhibited, regression caused, or onset delayed byadministering to a subject in need thereof an effective amount oreffective antipermeability amount of a formulation that when injectedintraperitoneally into a hamster delivers an amount of the therapeuticagent sufficient to achieve an average concentration of therapeuticagent in cheek tissue of the hamster equivalent to a rapamycinconcentration of any of about between 7 ng/g to 11 ng/g or between 11ng/g to 40 ng/g. In some variations, the diseases or conditionsdescribed herein are treated, prevented, inhibited, regression caused,or onset delayed by administering to a subject in need thereof aneffective amount or effective antipermeability amount of a formulationthat when injected intraperitoneally into a hamster delivers an amountof the therapeutic agent sufficient to achieve an average concentrationof therapeutic agent in cheek tissue of the hamster equivalent to arapamycin of any of about 7 ng/g, 11 ng/g, or 40 ng/g. In somevariations, the diseases or conditions described herein are treated,prevented, inhibited, regression caused, or onset delayed byadministering to a subject in need thereof an effective amount oreffective antipermeability amount of a formulation that when injectedintraperitoneally into a hamster delivers an amount of the therapeuticagent sufficient to achieve an average concentration of therapeuticagent in cheek tissue of the hamster equivalent to a rapamycin of any ofbetween 0.01 pg/g and 7 ng/g, between 0.1 pg/g and 7 ng/g, between 0.1pg/g and 1 ng/g, between 0.01 ng/g and 1 ng/g, between 0.1 pg/g and 5ng/g, between 5 ng/g and 15 ng/g, between 1 ng/g and 11 ng/g, between 1ng/g and 20 ng/g, between 10 ng/g and 40 ng/g, between 20 ng/g and 45ng/g.

In some variations, the diseases or conditions described herein aretreated, prevented, inhibited, regression caused, or onset delayed byadministering to a subject in need thereof an effective amount oreffective antipermeability amount of a formulation that delivers anamount of a therapeutic agent sufficient to achieve a concentrationequivalent to an amount of rapamycin in a tissue associated with thedisease or condition of any of between 0.01 pg/g and 7 ng/g, between 0.1pg/g and 7 ng/g, between 0.1 pg/g and 1 ng/g, between 0.01 ng/g and 1ng/g, between 0.1 pg/g and 5 ng/g, between 5 ng/g and 15 ng/g, between 1ng/g and 11 ng/g, between 1 ng/g and 20 ng/g, between 10 ng/g and 40ng/g, between 20 ng/g and 45 ng/g.

In some variations, the diseases or conditions described herein aretreated, prevented, inhibited, regression caused, or onset delayed byadministering to a subject in need thereof an effective amount oreffective antipermeability amount of a formulation that delivers anamount of a therapeutic agent sufficient to achieve a concentrationequivalent to an amount of rapamycin in a tissue associated with thedisease or condition of any of no greater than about 7 ng/g, no greaterthan about 11 ng/g, or no greater than about 40 ng/g. In somevariations, the diseases or conditions described herein are treated,prevented, inhibited, regression caused, or onset delayed byadministering to a subject in need thereof an effective amount oreffective antipermeability amount of a formulation that delivers anamount of a therapeutic agent sufficient to achieve a concentrationequivalent to an amount of rapamycin in a tissue associated with thedisease or condition of any of about between 7 ng/g to 11 ng/g orbetween 11 ng/g to 40 ng/g. In some variations, the diseases orconditions described herein are treated, prevented, inhibited,regression caused, or onset delayed by administering to a subject inneed thereof an effective amount or effective antipermeability amount ofa formulation that delivers an amount of a therapeutic agent sufficientto achieve a concentration equivalent to an amount of rapamycin in atissue associated with the disease or condition of any of about 7 ng/g,11.01 ng/g, or 40 ng/g.

In some variations, the diseases or conditions described herein aretreated, prevented, inhibited, regression caused, or onset delayed byadministering to a subject in need thereof an effective amount oreffective antipermeability amount of a formulation that delivers anamount of rapamycin sufficient to achieve a concentration of rapamycinin a tissue associated with the disease or condition of any of between0.01 pg/g and 7 ng/g, between 0.1 pg/g and 7 ng/g, between 0.1 pg/g and1 ng/g, between 0.01 ng/g and 1 ng/g, between 0.1 pg/g and 5 ng/g,between 5 ng/g and 15 ng/g, between 1 ng/g and 11 ng/g, between 1 ng/gand 20 ng/g, between 10 ng/g and 40 ng/g, between 20 ng/g and 45 ng/g.

In some variations, the diseases or conditions described herein aretreated, prevented, inhibited, regression caused, or onset delayed byadministering to a subject in need thereof an effective amount oreffective antipermeability amount of a formulation that delivers anamount of rapamycin sufficient to achieve a concentration of rapamycinin a tissue associated with the disease or condition of any of nogreater than about 7 ng/g, no greater than about 11 ng/g, or no greaterthan about 40 ng/g. In some variations, the diseases or conditionsdescribed herein are treated, prevented, inhibited, regression caused,or onset delayed by administering to a subject in need thereof aneffective amount or effective antipermeability amount of a formulationthat delivers an amount of rapamycin sufficient to achieve aconcentration of rapamycin in a tissue associated with the disease orcondition of any of about between 7 ng/g to 11 ng/g or between 11 ng/gto 40 ng/g. In some variations, the diseases or conditions describedherein are treated, prevented, inhibited, regression caused, or onsetdelayed by administering to a subject in need thereof an effectiveamount or effective antipermeability amount of a formulation thatdelivers an amount of rapamycin sufficient to achieve a concentration ofrapamycin in a tissue associated with the disease or condition of any ofabout 7 ng/g, 11 ng/g, or 40 ng/g.

Routes of Administration

The methods and formulations described herein deliver one or moretherapeutic agents to a subject, including but not limited to a humansubject.

In some variations, the methods and formulations described hereindeliver one or more therapeutic agents to an aqueous medium of a humansubject.

In some variations, the methods and formulations described hereindeliver one or more therapeutic agents to an aqueous medium in orproximal to an area where a disease or condition is to be treated,prevented, inhibited, onset delayed, or regression caused. In somevariations, the methods and formulations described herein systemicallydeliver one or more therapeutic agents to human subject to treat,prevent, inhibit, delay onset, or cause regression of a disease orconditions described herein.

In some variations, the methods and formulations described hereindeliver one or more therapeutic agents to an eye of a subject, includingthe macula and the retina choroid tissues, in an amount and for aduration effective to treat, prevent, inhibit, delay the onset of, orcause the regression of the diseases and conditions described in theDiseases and Conditions section.

“Retina choroid” and “retina choroid tissues,” as used herein, aresynonymous and refer to the combined retina and choroid tissues of theeye.

“Subconjunctival” placement or injection, as used herein, refers toplacement or injection between the sclera and conjunctiva.Subconjunctival is sometimes referred to herein as “sub-conj”administration.

Routes of administration that may be used in the methods describedherein to administer a formulation include but are not limited toplacement of the formulation, for example by injection, into a subject,including but not limited to an aqueous medium in the subject. In somevariations a formulation is administered systemically, including but notlimited to the following delivery routes: rectally, vaginally, byinfusion, intramuscularly, intraperitoneally, intraarterially,intrathecally, intrabronchially, intracisternally, cutaneously,subcutaneously, intradermally, transdermally, intravenously,intracervically, intraabdominally, intracranially, intraocularly,periocularly, intrapulmonarily, intrathoracically, intratracheally,nasally, buccally, sublingually, orally, parenterally, topically, byimplantation, as part of an embolization procedure, transcutaneously,directly into a nerve, directly into the optic nerve, direct injectioninto the optic nerve head, transretinally, transsclerally into an areaof effusion or exudation, or inhaled after nebulisation oraerosolization.

In some variations formulations comprising therapeutic agent areadministered directly to the eye using one or more of a variety ofprocedures, including but not limited to procedures in which (1) thetherapeutic agent is administered by injection using a syringe andhypodermic needle, (2) a specially designed device is used to inject thetherapeutic agent, (3) prior to injection of the therapeutic agent, apocket is surgically formed within the sclera to serve as a receptaclefor the therapeutic agent or therapeutic agent composition. For example,in one administration procedure a surgeon forms a pocket within thesclera of the eye followed by injection of a solution or formulationcomprising the therapeutic agent into the pocket.

Other administration procedures include, but are not limited toprocedures in which (1) a formulation of the therapeutic agent isinjected through a specially designed curved cannula to place thetherapeutic agent directly against a portion of the eye, (2) acompressed form of the therapeutic agent is placed directly against aportion of the eye, (3) the therapeutic agent is inserted into thesclera by a specially designed injector or inserter, (4) the formulationcomprising the therapeutic agent is incorporated within a polymer, (5) asurgeon makes a small conjunctival incision through which to pass asuture and any therapeutic agent delivery structure so as to secure thestructure adjacent to the sclera, (6) a needle is used for injectiondirectly into the vitreous of an eye, or into any other site described.

In some variations, rapamycin is incorporated into or coats a suture.

The formulations described herein may be used directly, for example, byinjection, as an elixir, for topical administration including but notlimited to via eye drops, or in hard or soft gelatin or starch capsules.The capsules may be banded to prevent leakage.

When the route of administration is oral, non-limiting examples of theformulation include solid, liquid, controlled-release, coated-bead,diffusion-based, reservoir-containing, tablets, chewable tablets,rapidly disintegrating, buccal, effervescent, and polymer-basedformulations.

In some variations the route of administration is by infusion. In somevariations, non-limiting examples of methods that may be used to deliverthe formulations described herein include infusion devices, IVadministration sets, IV pumps and/or controllers, IV catheters, premixedIV solutions, hypodermic products, prefilled syringes, hypodermicsyringes, hypodermic needles, gene/protein targeting or deliverysystems, hemodialysis, peritoneal dialysis, and enteral feedingproducts.

In some variations the route of administration is by inhalation. In somevariations, non-limiting examples of methods that may be used to deliverthe formulations described herein include metered dose inhalers, drypowder inhalers, nasal spray dispensers, ventilators, and nebulizers.

In some variations the route of administration is by a transdermal orimplantable systems. Non-limiting examples of methods that may be usedto deliver the formulations described herein include transdermal drugdelivery systems, implantable drug delivery systems, pulse generators,drug inserts, drug-containing devices, drug-coated devices, drug-elutingdevices, and drug-eluting stents.

One method that may be used to deliver the formulations described hereinis delivery by injection into a subject, including but not limited to ahuman subject.

In some variation the formulations described herein are placed proximateto the eye of a subject, including but not limited to intraocular andperiocular placement or injection. Nonlimiting examples of positionsthat are in or proximate to an eye of a subject include intracameral,anterior chamber, periocular, subconjunctival, subtenon, retrobulbar,peribulbar and posterior juxtascleral delivery. A “periocular” route ofadministration means placement near or around the eye. For a descriptionof exemplary periocular routes for retinal drug delivery, see Periocularroutes for retinal drug delivery, Raghava et al. (2004), Expert Opin.Drug Deliv. 1(1):99-114, which is incorporated herein by reference inits entirety.

In some variations the formulations described herein are administeredintraocularly. Intraocular administration includes placement orinjection within the eye, including in the vitreous.

Ocular sites to which the formulations may be administered include butare not limited to the vitreous, aqueous humor, sclera, conjunctiva,between the sclera and conjunctiva, the retina choroid tissues, macula,or other area in or proximate to the eye of a subject. Methods that maybe used for placement of the formulations include but are not limited toinjection.

Method of Preparing Formulations

One nonlimiting method that may be used for preparing the formulationsdescribed herein, including but not limited to liquid formulationscomprising rapamycin, is by mixing a solvent and a therapeutic agenttogether at room temperature or at slightly elevated temperature until asolution or suspension is obtained, with optional use of a sonicator,and then cooling the formulation. Other components including but notlimited to those described above may then be mixed with the formulation.Other preparation methods that may be used are described hereinincluding in the examples, and those of skill in the art will be able toselect other preparation methods based on the teachings herein and byconsulting relevant references such as Remington: The Science andPractice of Pharmacy, Twentieth Edition, Lippincott Williams andWilkins; 20th edition (Dec. 15, 2000).

In some variations, the formulations described herein compriserapamycin. In some variations, a rapamycin-containing formulationdescribed herein is stable for a period of time. In some variations, arapamycin-containing formulation described herein is stable for a periodof time, and is prepared by a method described in co-pending U.S.provisional patent application No. 60/772,018, filed Feb. 9, 2006. Insome variations, a rapamycin-containing formulation described herein isstable for a period of time, and is preparable by a method described inco-pending U.S. provisional patent application No. 60/772,018, filedFeb. 9, 2006.

Extended Delivery of Therapeutic Agents

For treatment, prevention, inhibition, delaying the onset of, or causingthe regression of certain diseases or conditions, it may be desirable tomaintain delivery of a therapeutically effective amount of thetherapeutic agent for an extended period of time. Depending on thedisease or condition being treated, prevented, inhibited, having onsetdelayed, or being caused to regress this extended period of time may beat least about 1 week, at least about 2 weeks, at least about 3 weeks,at least about 1 month, at least about 3 months, at least about 6months, at least about 9 months, or at least about 1 year. Generally,however, any extended period of delivery may be possible. Atherapeutically effective amount of agent may be delivered for anextended period by a formulation that maintains for the extended perioda concentration of agent in a subject or in a tissue of a subjectsufficient to deliver a therapeutically effective amount of agent forthe extended time.

In some variations a formulation described herein delivers anapproximately constant level of the therapeutic agent for one or more ofthe extended periods of time described herein. “Approximately constant,”as used herein, means that the average level does not vary by more thanone order of magnitude over the extended period of time, i.e., thedifference between the maximum and minimum is less than a 10-folddifference for measurements of the average concentration at times in therelevant period of time.

Delivery of a therapeutically effective amount of the therapeutic agentfor an extended period may be achieved via a single placement of aformulation or may be achieved by two or more placements of aformulation. The optimal dosage regime will depend on the therapeuticamount of the therapeutic agent needing to be delivered, and the periodover which it need be delivered. Those versed in such extendedtherapeutic agent delivery dosing will understand how to identify dosingregimes that may be used based on the teachings provided herein.

When using certain therapeutic agents or for the treatment, prevention,inhibition, delaying the onset of, or causing the regression of certaindiseases, it may be desirable for delivery of the therapeutic agent notto commence immediately upon placement of the formulation into thesubject, but for delivery to commence after some delay. For example, butin no way limiting, such delayed release may be useful where thetherapeutic agent inhibits or delays wound healing and delayed releaseis desirable to allow healing of any wounds occurring upon placement ofthe formulation. Depending on the therapeutic agent being deliveredand/or the diseases and conditions being treated, prevented, inhibited,onset delayed, and regression caused this period of delay beforedelivery of the therapeutic agent commences may be about 1 hour, about 6hours, about 12 hours, about 18 hours, about 1 day, about 2 days, about3 days, about 4 days, about 5 days, about 6 days, about 7 days, about 8days, about 9 days, about 10 days, about 11 days, about 12 days, about13 days, about 14 days, about 21 days, about 28 days, about 35 days, orabout 42 days. Other delay periods may be possible. Delayed releaseformulations that may be used are known to people versed in thetechnology.

In some variations, a formulation as described herein contains an amountof a therapeutic agent equivalent to an amount of rapamycin.

In some variations, any one or more of the formulations described hereinare administered systemically every 3 or more months, every 6 or moremonths, every 9 or more months, or every 12 or more months, or longer,to treat one or more of the diseases or conditions described herein. Insome variations, any one or more of the formulations described hereinare administered parenterally every 3 or more months, every 6 or moremonths, every 9 or more months, or every 12 or more months, or longer,to treat one or more of the diseases or conditions described herein.

In some variations, any one or more of the formulations described hereinare administered locally every 3 or more months, every 6 or more months,every 9 or more months, or every 12 or more months, or longer, to treatone or more of the diseases or conditions described herein. In somevariations, any one or more of the formulations described herein areadministered by implantation every 3 or more months, every 6 or moremonths, every 9 or more months, or every 12 or more months, or longer,to treat one or more of the diseases or conditions described herein.

In some variations, any one or more of the formulations described hereinare administered intravitreally every 3 or more months, every 6 or moremonths, every 9 or more months, or every 12 or more months, or longer,to treat one or more of the diseases or conditions described herein. Insome variations, any one or more of the formulations described hereinare administered subconjunctivally every 3 or more months, every 6 ormore months, every 9 or more months, or every 12 or more months, orlonger, to treat one or more of the diseases or conditions describedherein.

Dosages of various therapeutic agents for treatment, prevention,inhibition, delay of onset, or cause of regression of various diseasesand conditions described herein can be refined by the use of clinicaltrials.

EXAMPLES Example 1 Antipermeability Effect of Rapamycin in Hamster CheekPouch Model Using VEGF

A hamster cheek pouch model was used to study the antipermeabilityeffect of rapamycin. In this model, a tracer molecule was injectedintravenously into a hamster, and various combinations of VEGF (apermeability enhancer in hamster cheek pouch microcirculation),rapamycin (the test compound), and various controls were administered tothe hamster to determine their effect on VEGF-induced permeability. Thelevel of tracer was measured by imaging with computer-assisted digitalimage analysis. A higher integrated optical intensity indicated a higherdegree of permeability.

This protocol was modeled directly upon the Materials and Methodssection of Aramoto et al., Vascular endothelial growth factor stimulatesdifferential signaling pathways in the in vivo microcirculation, Am JPhysiol:Heart Circ Physiol. 287: H1590-H1598, (2004) (“Aramoto 2004.”),with the following features.

A total of 42 male golden Syrian hamsters, weighing 80-120 g, were used.The hamsters were anesthetized with sodium pentobarbital (50 mg/kg, ip).Tracheotomy was performed to facilitate breathing; cannulation of leftjugular vein was used for administration of flourochrome and additionalanesthetic. The left carotid was cannulated for collection of blood andblood pressure monitoring. The right hamster cheek pouch was preparedfor direct visualization and intervention using the methods of Mayhanand Joyner, The Effect Of Altering The External Calcium ConcentrationAnd A Calcium Channel Blocker, Verapamil, On Microvascular Leaky SitesAnd Dextran Clearance In The Hamster Cheek Pouch, Microvasc. Res. 28(2):159-79 (1984); see also Aramoto 2004. A removable plastic two pieceLucite chamber with 1 ml reservoir capacity was placed in the cheekpouch to observe and collect suffusate from the microvasculature.

The chamber reservoir was filled with bicarbonate buffer (in millimolar:NaCl 131.9, KCl 4.7, CaCl 2 2.0, MgSO4 1.2 NaHCO3 18.0; pH 7.35; bufferbubbled with a 95% N2 and 5% CO2 gas mixture to maintain oxygen tensionat approximately 10 mm Hg and pH at 7.4) and tested for leakage.

Vascular leak in the hamsters was observed A Nikon Optiphot or OlympusBH microscope for one hour with suffusate 1 ml/min prior to topicalapplication of VEGF.

Forty-five minutes into the stabilization period the tracer wasadministered. Fluorescein isothiocyanate-dextran 150 (FITC-Dx 150;MW=150 kDa; Sigma Chemicals Co., St. Louis, Mo.) was used as a tracerfor microvascular permeability to macromolecules. It was administeredintravenously as a 100 mg/kg bolus and followed by continuous infusion(0.15 mg/kg/min) to maintain a steady plasma concentration throughoutthe duration of the study. Microvascular transport was assessed bymeasuring integrated optical intensity (JOT) by computer-assisteddigital image analysis. Two or three fields were randomly selected inthe cheek pouch and recorded on an Image-1 computer system (UniversalImaging Corporation) before and after the application of the VEGF. Eachfield included 4-6 postcapillary venules ranging from 15 to 30 μm indiameter; the field was relatively free of capillaries. The maximal IOIwas measured at 10, 20, 30, 33, 35, 40, 50, 60, 70, 80 and 90 minutesafter topical application of VEGF. The higher the IOI, the higher thepermeability.

RAPAMUNE (oral rapamycin suspension) was used for intraperitoneal dosingas follows. The RAPAMUNE oral suspension was formulated as a 1 mg/mLsolution, and is made by Wyeth and was obtained from a pharmacy.RAPAMUNE Oral Solution bottles were stored protected from light andrefrigerated at 2° C. to 8° C. (36° F. to 46° F.). Once the bottle wasopened, the contents were used within one month. After any necessarydilution, the preparation was used immediately.

There were four RAPAMUNE treatment groups corresponding to four doses ofRAPAMUNE administered: 10 mg/kg (6 animals), 2 mg/kg (5 animals), 0.5mg/kg (5 animals), and 0.1 mg/kg (5 animals). Hamsters were weighed anddosed accordingly. For example, a 100 g Hamster in the 2 mg/kg dosegroup was dosed intraperitoneally with 0.2 cc of the RAPAMUNEsuspension. Each treatment group was intraperitoneally administered theappropriate amount of RAPAMUNE at day −1, and again 1 hour prior tostart of VEGF topical application.

0.5 mL of the RAPAMUNE vehicle was intraperitoneally administered toeach of 3 animals. The RAPAMUNE vehicle is 99% Phosal 50 PG obtainedfrom American Lecithin Co. (Oxford Conn.) (phosphatidylcholine,propylene glycol, mono- and di-glycerides, ethanol, soy fatty acids, andascorbyl palmitate) and 1% Tween 80 obtained from Sigma-Aldrich (StLouis, Mo.).

As a positive control group, four hamsters were intraperitoneallyadministered 1 mg/kg caveolin-1 (“Cav-1) scaffold 1 day prior to studyof the cheek pouch permeability. Cav-1 is a potent endothelial nitricoxide syntase (eNOS) inhibitor. Bucci et al. have shown that Cav-1scaffolding domain peptide IP injection attenuated vascular leakage andoverall interstitial edema. Nature Medicine 6: 1362-1367 (2000). Bucciet al. also showed that Cav-1 scaffolding domain peptide suppressedcarrageenan-induced edema formation and that its anti-inflammatoryproperties had a similar effect as dexamethasone application. Morerecently it has also been shown that caveolin-1 impairs microvascularpermeability and angiogenesis through the Akt-eNOS pathway. PNAS 102:204-209 (2005).

The VEGF was a recombinant human VEGF165, obtained from R&D Systems(Minneapolis, Minn.). VEGF was applied topically via a side-port toachieve a 10⁻⁸ M concentration in the hamster cheek pouch chamber, asdescribed further in Aramoto 2004. One dose of VEGF was applied per eachanimal in each treatment group, except the RAPAMUNE vehicle groupreceived no VEGF. Suffusion was reestablished and effluent collected for90 minutes. Images were acquired at 10, 20, 30, 33, 35, 40, 50, 60, 70,80 and 90 minutes after VEGF administration. Images were acquireddirectly to a computer via either Universal Imaging's Image-1 program orthe Universal Imaging's MetaMorph program.

The permeability data is shown in FIG. 1 and Table 1. “R” refers torapamycin treatment in the figure legend. At 90 minutes, treatment with0.1 mg/kg was correlated with a greater than 85% reduction in meanpermeability relative to the vehicle and VEGF treatment. At 90 minutes,treatment with 0.5 mg/kg was correlated with a greater than 90%reduction in mean permeability relative to the vehicle and VEGFtreatment. At 90 minutes, treatment with 2 mg/kg RAPAMUNE and VEGF wascorrelated with a greater than 30% reduction in mean permeabilityrelative to the vehicle and VEGF treatment. At 90 minutes, treatmentwith 10 mg/kg RAPAMUNE and VEGF was correlated with greater permeabilitythan treatment with just VEGF.

Thus, the data show that VEGF increased permeability of themicrovasculature in the hamster cheek pouch. Rapamycin antagonizespermeability at very low doses. At the 2 mg/kg dose, rapamycin continuedto antagonize VEGF-induced permeability, but to a lesser degree than the0.1 and 0.5 mg/kg doses. At 10 mg/kg of rapamycin, rapamycin'santipermeability effect was inhibited.

Statistical analysis. Because the baseline remained constant throughoutthe experiment at values ranging from 3 to 5 IOI units, the baseline wassubtracted and the transport data are presented as net IOI values. Alldata are presented as mean±the standard deviation. Statistical analysiswas performed using a one-way analysis of variance. When significantvalues were obtained, the Student-Newman-Keuls test was applied todetermine which measurements differed significantly from one another.Differences were considered significant for values of P<0.05.

The onset of rapamycin's antipermeability effect was delayed compared tothat of Cav-1, and the period of the delay was dependent upon the amountof RAPAMUNE administered.

At later timepoints in the assay rapamycin was a more potentantipermeability agent than Cav-1. Though not bound by theory, it isbelieved that the later timepoints are particularly relevant in theclinical setting.

TABLE 1 Permeability Study Data A B C D E F G 10 mg/kg Caveolin 500μg/kg Vehicle + R + 1 mg/kg + R + Vehicle VEGF 2 mg,/kg R + VEGF VEGFVEGF only 100 μg/kg R + Time (N = 5) VEGF (N = 5) (N = 6) (N = 4) (N =5) (N = 3) VEGF (N = 5) (min) Mean SEM Mean SEM Mean SEM Mean SEM MeanSEM Mean SEM Mean SEM 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 0 00 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33 5.2 3.3 2 1 11 4.5 0.9 0.50.5 0.4 0.5 0.5 2.8 2.2 35 6.7 3.7 1.8 1.1 11.8 3.7 2.5 1.1 1.8 1.8 0.90.9 4.1 2.7 40 9.4 5.6 5.2 3 21.6 5.5 3.4 1.8 6 3.5 2.3 2.3 8.4 3.4 4514.8 7.2 14.5 6.3 37.1 10 3.6 1.8 14.9 9.1 3 3 15.1 5.6 50 24.7 6.8 248.8 43.1 11.8 5.3 2.9 15.6 9.2 3.2 3.2 17.2 7.4 60 37.5 5.7 34.6 7.762.1 15.3 6.8 3.5 9.9 6.3 3.5 3 19.3 8.4 70 54.6 5.2 34.6 5.1 77.2 8.410.9 4.4 6.1 5.4 3.4 3.4 17.9 7.8 80 63 4.2 40.2 7.7 84.4 7.8 16.4 9 3.62.7 3.4 3.4 9.7 5 90 71.3 7.7 43.5 12.4 78.6 9.1 13.3 7 4 1.1 3.3 3.38.7 4.3

Upon sacrifice of the animals, samples of both of the Hamster cheekswere obtained and frozen at −80 degrees Celsius. The samples werelabeled as to the amount of intraperitoneal dose received, and whetherthey were right (studied with chamber) or left. The full tissue samplewas homogenized and analyzed for rapamycin levels by LC/MS. Results areprovided in Table 2.

TABLE 2 Rapamycin Assayed Concentration in Hamster Check PouchHomogenate Homogenate Average SEM Sample Conc. Conc. (ng/g or (ng/g orDosing ID (ng/mL) (ng/g) pg/mg) pg/mg) 0.1 mg/kg 37 L 0.510 5.10 7.373.09 37 R 1.18 11.8 38 L 0.248 2.48 38 R 0.714 7.14 39 L 0.741 7.41 39 R1.15 11.5 40 L 0.418 4.18 40 R 0.919 9.19 41 L 0.561 5.61 41 R 0.9269.26 0.5 mg/kg  1 L 1.07 10.7 11.01 10.72  1 R 1.31 13.1  2 L 1.45 14.5 2 R 3.46 34.6  3 L 0.0784 0.784  3 R 0.0805 0.805  4 L 0.0743 0.743  4R 0.272 2.72  5 L 1.24 12.4  5 R 1.97 19.7 2 mg/kg 18 R 4.34 43.4 40.8323.85 19 L 2.00 20.0 19 R 5.69 56.9 21 L 4.65 46.5 21 R 6.91 69.1 23 L3.09 30.9 23 R 7.65 76.5 24 L 1.25 12.5 24 R 1.17 11.7 10 mg/kg 13 L4.33 43.3 55.15 12.86 13 R 5.76 57.6 14 L 3.95 39.5 14 R 4.79 47.9 15 L3.93 39.3 15 R 5.86 58.6 25 L 8.12 81.2 25 R 7.27 72.7 26 L 5.00 50.0 26R 5.11 51.1 27 L 5.64 56.4 27 R 6.42 64.2 Vehicle  6 L BQL BQL 1.28 0.74 6 R BQL BQL 35 L 0.203 2.03 35 R 0.0559 0.559 36 L BQL BQL 36 R 0.1241.24 BQL = below quantitation limit (0.03 ng/mL). A dilution factor of10 was applied to report this data in ng/g units.

The 0.1 mg/kg treatment group was correlated with an average tissuelevel of 7.37 ng/g of rapamycin in the hamster cheek pouch. The 0.5mg/kg treatment group was correlated with an average tissue level of11.01 ng/g of rapamycin in the hamster cheek pouch. The 2.0 mg/kgtreatment group was correlated with an average tissue level of 40.83ng/g of rapamycin in the hamster cheek pouch. The 10 mg/kg treatmentgroup was correlated with an average tissue level of 55.15 ng/g ofrapamycin in the hamster cheek pouch. The vehicle control treatmentgroup was correlated with an average tissue level of 1.28 ng/g ofrapamycin in the hamster cheek pouch. Thus, increased dosing wascorrelated with higher tissue levels of rapamycin in the hamster cheekpouch. Additionally, the vehicle control revealed some background in therapamycin concentration assay.

Example 2 Antipermeability Effect of Rapamycin in Hamster Cheek PouchModel Using PAF

The antipermeability effect of rapamycin in response toplatelet-activating factor (PAF) was analyzed. The protocol of Example1, using PAF (1-o-alkyl-2-acetyl-sn-3-glycero-phosphoryl-choline; SigmaChemical Co., St. Louis, Mo.) in the place of VEGF, was performed,except PAF was applied topically via a side-port to achieve a 10⁻⁷ Mconcentration in the hamster cheek pouch chamber. A 0.5 mg/kg dose ofRAPAMUNE was intraperitoneally administered at day −1, and again 1 hourprior to start of PAF topical application. A vehicle-only negativecontrol and a vehicle+PAF positive control were also used. There were 3animals per treatment group.

The permeability data are shown in FIG. 2. “R” refers to rapamycintreatment in the figure legend. The PAF treatment was correlated with asignificantly higher level of permeability than the vehicle control.Treatment with 0.5 mg/kg rapamycin plus PAF was correlated with reducedpermeability relative to the PAF treatment alone. At 20 minutes, forexample, treatment with 0.5 mg/kg was correlated with a 65% reduction inmean permeability relative to the vehicle plus PAF treatment. Rapamycinplus PAF treatment resulted in reduced permeability relative toPAF-treated animals throughout the experiment.

VEGF is a permeability-altering agent associated with vasodilation,whereas PAF is a permeability-altering agent associated withvasoconstriction. Results with PAF confirm the anti-permeability resultsof rapamycin which were observed with VEGF.

Example 3 Arteriolar Diameter Effect of Rapamycin

Arteriolar diameter was measured as the width of epi-illuminated bloodcolumn using a MetaMorph image system. Two or three arterioles withdiameter of 20-30 μm were studied per animal. Baseline diametermeasurements were normalized to a value of one. For each vessel, theexperimental diameter was expressed as a ratio of baseline diameter(relative luminal diameter). To compare diameter before and after anagonist application, diameters were measured at the same place in thearterioles of interest.

The arterial vasodilation data is shown in FIG. 3 and FIG. 4. In FIG. 3,there were 3 animals per treatment group. “R vehicle” refers to therapamycin vehicle, as indicated in the figure legend. VEGF treatmentresulting in a significantly increased relative luminal diameter ascompared to the vehicle treatment. Pretreatment with rapamycin vehicledid not cause any significant change of arteriolar diameter. Topicalapplication of 10⁻⁸ M VEGF for 3 minutes produced strong vasodilation.The ratio of experimental to baseline arteriolar diameter graduallyincreased and achieved its peak at 30 min after application of VEGF; thearteriolar diameter ratio increased from 1.0 to 1.46±0.09 (P<0.05).After the peak, the arteriolar diameter ratio gradually decreased andreached ˜80% of baseline value at 50 min after application of VEGF. At30-min after VEGF application, 500 μg/kg rapamycin attenuated theincrease in relative luminal diameter induced by VEGF 10-8 M from1.46±0.09 to 1.09±0.04 (P=0.02; FIG. 3).

FIG. 4 shows the effect of 500 μg/kg rapamycin on PAF-stimulatedvasoconstriction. In FIG. 4, there were 3 animals per treatment group.The baseline values of arteriolar diameter did not change significantlyin a 30-min period. PAF applied topically for 3 min at 10⁻⁷ M producedstrong vasoconstriction. The ratio of experimental to baselinearteriolar diameter fell from 1.0 to 0.32±0.02 within 5 min after thetopical application of PAF. On removal of PAF and reinstitution ofsuffusate flow, the arteriolar diameter ratio gradually increased andachieved ˜90% of baseline value within 15 min. Pretreatment with 500μg/kg rapamycin did not attenuate the vasoconstrictor action of PAF.

All references cited herein, including patents, patent applications, andpublications, are hereby incorporated by reference in their entireties,whether previously specifically incorporated or not.

We claim:
 1. A method to decrease vascular permeability in a subjectwith diabetic macular edema, comprising administering a therapeuticagent to the subject at a dose of no greater than an amount equivalentto 2 mg/kg of rapamycin, wherein the therapeutic agent is rapamycin, ora pharmaceutically acceptable salt thereof.
 2. The method of claim 1,wherein the subject is a human subject.
 3. The method of claim 1,wherein the therapeutic agent is rapamycin.
 4. The method of claim 1,wherein the therapeutic agent is administered to the subject in needthereof at a dose of no greater than an amount equivalent to 0.5 mg/kgof rapamycin.
 5. The method of claim 1, wherein the therapeutic agent isadministered to the subject in need thereof at a dose of no greater thanan amount equivalent to 0.27 mg/kg of rapamycin.
 6. The method of claim1, wherein the therapeutic agent is administered to the subject in needthereof at a dose of no greater than an amount equivalent to 0.07 mg/kgof rapamycin.
 7. The method of claim 1, wherein the therapeutic agent isadministered to the subject in need thereof at a dose of no greater thanan amount equivalent to 0.014 mg/kg of rapamycin.
 8. The method of claim1, wherein the therapeutic agent is rapamycin, and the rapamycin isadministered in a formulation containing about 2% w/w rapamycin, about4% w/w ethanol, and about 94% w/w PEG 400.